Blood pressure levels and cardiovascular risk according to age in patients with diabetes mellitus: a nationwide population-based cohort study

Abstract

Background Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age. Methods Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke. Results Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130–139/80–89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130–139/80–89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130–139/80–89 mmHg and BP 120–129/70–79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130–139/80–89 mmHg at all ages. Conclusions In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130–139/80–89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130–139/80–89 mmHg at the age of ≥ 70.

Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease

“…In this PARADIGM substudy, all participants were East Asians; hence, this might limit the generalizability of the findings. Fourth, the target blood pressure might be somewhat different in an elderly population 39 . However, this study could not evaluate this issue because only five (4.9%) participants aged over 70 years.…”

“…Fourth, the target blood pressure might be somewhat different in an elderly population. 39 However, this study could not evaluate this issue because only five (4.9%) participants aged over 70 years. Finally, the small sample size and relatively short-term followup periods were the weaknesses of the present study.…”

Association of uncontrolled blood pressure in apparent treatment‐resistant hypertension with increased risk of major adverse cardiovascular events plus

“…The greater risk of MACE+ in the sensitivity analysis validates our hypothesis and other findings that elevated BP is associated with a higher risk of MACE+. [23][24][25] Thus, while the absolute number of patients meeting this less stringent criterion was reduced relative to the primary analysis, the risk for MACE+ was higher. This highlights the importance of earlier BP control using the more stringent 130/80 mmHg cutoff in potentially reducing the risk for CV events.…”

Therapeutic Potential of Ursolic Acid in Cancer and Diabetic Neuropathy Diseases

“…A low-grade chronic inflammation, uptake of glucose in adipose and skeletal tissues and various flaws in the intracellular insulin pathway play crucial functions in insulin resistance [34]. Diabetes is a significant health problem, comprising a complex disorder strongly related to nephropathy, cardiomyopathy, and neurodegeneration [35]. Diabetic individuals might suffer from peripheral and central nervous neuropathy, which is linked with impairments in memory and learning [36][37][38][39][40].…”