Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study

Abstract

Background Controversy persists about the relationship of blood pressure with cardiovascular diseases (CVD) in diabetes and associated disease burden. We assessed these associations among Chinese adults with type 2 diabetes (T2D). Methods In 2004–08, the China Kadoorie Biobank recruited >512,000 adults aged 30–79 years from 10 localities across China, including 26,315 with T2D (based on self-report or plasma glucose measurement) but no prior CVD, followed-up for ~9 years. Cox regression yielded adjusted HR for major CVD and all-cause mortality associated with 10 mmHg higher usual (longer-term average) SBP. Attributable fractions were estimated to assess cardiovascular mortality burden due to uncontrolled hypertension (SBP ≥130 mmHg or DBP ≥80 mmHg). Findings Overall, 75.7% of participants had self-reported (24.8%) or screen-detected (50.9%) (SBP ≥130 mmHg or DBP ≥80 mmHg) hypertension. Among individuals with self-reported hypertension, 82.3% were treated, of whom 9.3% achieved control. There were positive log-linear associations of blood pressure with CVD, with no evidence of a threshold down to ~120 mmHg for usual SBP. Each 10 mmHg higher usual SBP was associated with HR of 1.28 (95% CI 1.25–1.30), 1.18 (1.15–1.21), 1.17 (1.15–1.19) and 1.45 (1.38–1.52) for cardiovascular death ( n =1807), major coronary event ( n =1190), ischaemic stroke ( n =4362) and intracerebral haemorrhage ( n =469), respectively. There was an apparent J-shaped association with all-cause mortality ( n =4503). In this diabetes population, uncontrolled hypertension accounted for 39% of cardiovascular deaths. Interpretation Uncontrolled hypertension is common in Chinese adults with T2D, resulting in substantial excess risks of CVD. Improved hypertension management could avoid a large number of cardiovascular-related deaths. Funding Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF.

Targeting autonomic nervous system as a biomarker of well-ageing in the prevention of stroke

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Cost-Utility Analysis of the Integrated Care Models for the Management of Hypertension Patients: A Quasi-Experiment in Southwest Rural China

“…Despite the large sample size, wide universality, and favorable extrapolation effect of the model, the utilities obtained might be biased. (2) The data sources of all the model parameters were not completely identical. If the data were missing in the CMB-OC project, we obtained the parameter values from data from other trials and relevant literature.…”

“…We used the Markov model to predict and analyze the long-term cost-effectiveness of integrated care for the management of patients with hypertension, and the results provide an evidence-based reference for integrated care to improve the efficiency of the healthcare delivery system. (2) In this study, we selected the intervention programs according to local conditions and designed an integrated care model combining MDT, MIP, and SGB-P4P. The study design has compensated for the factors missing from the healthcare delivery system for the management of chronic diseases in China, including multi-team human resources, standardized pathways, and incentive measures.…”

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GJD Modulates Cardiac/Vascular Inflammation and Decreases Blood Pressure in Hypertensive Rats

“…One million persons from 44 low and middle income countries were studied; 17.5% were hypertensive; 39.2% were diagnosed with high blood pressure; and 29.9% were treated, yet only 10.3% had their hypertension under control [ 2 ]. Uncontrolled hypertension is associated with a higher risk of cardiovascular disease death [ 3 , 4 ]. Furthermore, people with hypertension have a higher chance of developing cardiovascular disease (CVD) throughout their lives, and the onset of CVD morbidity occurs five years earlier in those with hypertension compared to those with normal blood pressure [ 5 , 6 ].…”