Blood pressure indices and cardiovascular disease mortality in persons with or without diabetes mellitus

Gomadam, Pallavi; Shah, Amit; Qureshi, Waqas; Yeboah, Phyllis; Freedman, Barry I.; Bowden, Donald W.; Soliman, Elsayed Z.; Yeboah, Joseph

doi:10.1097/hjh.0000000000001509

Cited by 17 publications

(5 citation statements)

References 24 publications

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“…In conclusion, our data showed that low on treatment DBP does not independently influence cardiovascular risk in patients allocated to intensive and standard blood pressure lowering strategies. These results are in line with the conclusions of similar studies 11–14,27 . In that context, low on-treatment DBP should be considered as a marker of high cardiovascular risk rather than an independent risk factor 26 .…”

Section: Discussionsupporting

confidence: 93%

“…The J-shaped curve relationship between DBP and cardiovascular mortality was also observed after long-term follow-up in the analysis of the National Health and Nutrition Examination Survey III and Diabetes Heart Study performed by Gomadam et al . 27 Our multivariable Cox model showed that DBP was not a significant cofactor. Based on the data obtained from this study and previous studies, the evidence for a J-shaped relationship between DBP and cardiovascular risk is inconclusive.…”

Section: Discussionmentioning

confidence: 76%

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Low on-treatment diastolic blood pressure and cardiovascular outcome: A post-hoc analysis using NHLBI SPRINT Research Materials

Sobieraj

Lewandowski

Siński

et al. 2019

Sci Rep

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Recent studies including the SPRINT trial have shown beneficial effects of intensive systolic blood pressure reduction over the standard approach. The awareness of the J-curve for diastolic blood pressure (DBP) causes some uncertainty regarding the net clinical effects of blood pressure reduction. The current analysis was performed to investigate effects of low on-treatment DBP on cardiovascular risk in the SPRINT population. The primary composite outcome was the occurrence of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes. The prevalence of primary outcomes was significantly higher in subjects within low DBP in both standard (44–67 mmHg [10.8%] vs 67–73 mmHg [6.7%] vs 73–78 mmHg [5.1%] vs 78–83 mmHg [4.4%] vs 83–113 mmHg [4.3%], p < 0.001) and intensive treatment (38–61 mmHg [6.7%] vs 61–66 mmHg [4.1%] vs 66–70 mmHg [4.5%] vs 70–74 mmHg [2.7%] vs 74–113 mmHg [3.4%], p < 0.001) arms. After adjusting for covariates, low DBP showed no significant effects on cardiovascular risk. Therefore, while reaching blood pressure targets, low DBP should not be a matter of concern.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 76%

Low on-treatment diastolic blood pressure and cardiovascular outcome: A post-hoc analysis using NHLBI SPRINT Research Materials

Sobieraj

Lewandowski

Siński

et al. 2019

Sci Rep

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“…Abundant clinical data indicate a close correlation between the amplitude, frequency, and characteristic points of pulse waves and cardiovascular diseases [3]. By examining the relationship between pulse waves and various parameters of the cardiovascular system, it is possible to assess the health status of the human cardiovascular system [4]. Therefore, developing a device that is comfortable and capable of continuously monitoring human Micromachines 2024, 15, 659 2 of 18 pulse signals holds practical significance for the prevention and treatment of diseases such as hypertension and cardiovascular ailments.…”

Section: Introductionmentioning

confidence: 99%

An Intelligent Non-Invasive Blood Pressure Monitoring System Based on a Novel Polyvinylidene Fluoride Piezoelectric Thin Film

Li,

Zhou,

Liu

et al. 2024

Micromachines

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Hypertension is a common cause of cardiovascular diseases, closely associated with the high mortality and disability rates of cardiovascular diseases such as stroke and coronary heart disease. Therefore, developing a comfortable and sustainable device for monitoring human pulse signals holds practical significance for the prevention and treatment of hypertension and cardiovascular diseases. PVDF flexible pressure sensors possess the characteristics of high sensitivity, good flexibility, and strong biocompatibility, thereby demonstrating extensive application potential in areas such as health monitoring, wearable devices, and electronic skins. This paper focuses on the development of a modified piezoelectric polymer and its application in an intelligent blood pressure monitoring system, demonstrating its outstanding performance and feasibility through a series of experiments. This research provides innovative material choices for the development of intelligent medical devices and offers beneficial guidance for the design and application of future intelligent health monitoring systems.

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“…Most previous large studies of the association of blood pressure with CVD in diabetes involved mainly Western populations [6 , 8 , 9] . Hypertension and diabetes are more common and frequently less well-controlled in China [17] , [18] , [19] ], and population differences are proposed in the underlying pathophysiology of T2D [20] .…”

Section: Introductionmentioning

confidence: 99%

“…Large prospective observational studies [3 , 4] and randomised controlled trials [5] have consistently demonstrated that intensive control of blood pressure (target systolic blood pressure [SBP] < 120 mmHg) is associated with lower risks of CVD in the general population. However, the evidence is less clear among individuals with diabetes, with some studies reporting comparable risks to those in the general population [3 , 6 , 7] , while others have reported higher CVD [8 , 9] and all-cause [8] mortality risks at lower SBP levels (SBP < 130 mmHg [8] or < 120 mmHg [9] ). Furthermore, the large ACCORD BP trial failed to demonstrate any benefit of a SBP target of < 120 mmHg when compared with < 140 mmHg among individuals with type 2 diabetes (T2D) [10] , with meta-analyses of trial data suggesting possible adverse CVD [11] and non-CVD [12] effects of intensive blood pressure lowering.…”

Section: Introductionmentioning

confidence: 99%

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

Bragg

Halsey

Guo

et al. 2021

The Lancet Regional Health - Western Pacific

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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.

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Blood pressure indices and cardiovascular disease mortality in persons with or without diabetes mellitus

Abstract: The association between SBP and CVD mortality risk is nonlinear but different in diabetes mellitus (U-shaped) and NON-DM (J-shaped), explaining why aggressive blood pressure lowering may have different outcomes in these two groups.

Cited by 17 publications

References 24 publications

Low on-treatment diastolic blood pressure and cardiovascular outcome: A post-hoc analysis using NHLBI SPRINT Research Materials

Low on-treatment diastolic blood pressure and cardiovascular outcome: A post-hoc analysis using NHLBI SPRINT Research Materials

An Intelligent Non-Invasive Blood Pressure Monitoring System Based on a Novel Polyvinylidene Fluoride Piezoelectric Thin Film

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

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