Blood pressure levels and risk of cardiovascular events and mortality in type-2 diabetes

Sundström, Johannes; Sheikhi, Reza; Östgren, Carl Johan; Svennblad, Bodil; Bodegård, Johan; Nilsson, Peter M.; Johansson, Gunnar

doi:10.1097/hjh.0b013e32836123aa

Cited by 43 publications

(34 citation statements)

References 26 publications

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“…3 Bangalore et al 20 examined the continuous relationship between cardiovascular risk expressed as HR and BP and reported the lowest point of risk in their population (95% hypertensive) with associated abnormal serum lipids. Sundstrom et al 21 performed a similar analysis in over 34 000 primary care patients with a wide range of BP values (40% hypertensive). However, these authors also divided their subjects into 5 risk categories to examine the relationship between BP and HR.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

et al. 2016

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T wo aspects of hypertension that have received considerable attention in recent years are the threshold blood pressure (BP) for diagnosing hypertension and the optimum BP target after drug therapy has been initiated. In each instance, greater emphasis is now given to systolic BP, primarily because it has been shown in numerous studies to be the best predictor of cardiovascular risk. Thresholds for the initiation of therapy based on increases in future cardiovascular events in relation to BP have been determined 1-3 for 24-hour ambulatory BP monitoring, home BP, and electronic, automated office BP (AOBP). As for conventional manual office BP, treatment thresholds were mainly derived from placebo-controlled clinical trials. For example, in the SHEP trial (Systolic Hypertension in the Elderly Program), 4 hypertension was defined as a systolic BP of 160 mm Hg or higher, and the target BP was a decrease of at least 20 mm Hg to <150 mm Hg. This study provided evidence to support treating isolated systolic hypertension of 160 mm Hg or higher in the elderly. Clinical outcome data that would justify treating uncomplicated, mild diastolic hypertension (90-99 mm Hg) based on placebo-controlled clinical trials are lacking. Other epidemiological studies 5 have shown an increase in cardiovascular events in mixed treated and untreated populations starting at a BP ≥115/75 mm Hg. However, these findings only relate BP to the future risk of a cardiovascular event and do not address the optimum BP after drug therapy has been started. Overall, convincing evidence for initiating drug therapy for uncomplicated, mild hypertension (BP 140-159/90-99 mm Hg) based on office BP is limited.There has also not been a specific target BP for treating systolic hypertension, with some guidelines recommending a <150 mm Hg target in the elderly based on the results of the SHEP trial, whereas others have maintained the Abstract-The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

et al. 2016

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“…The growing prevalence of type 2 diabetes mellitus (T2DM) has become a global public health concern, and also contributes to an increasing economic burden on healthcare systems [1][2][3][4][5]. Progression of T2DM increases the risk of medical complications and healthcare resources use.…”

Section: Introductionmentioning

confidence: 99%

Healthcare utilization and costs following newly diagnosed type-2 diabetes in Sweden: A follow-up of 38,956 patients in a clinical practice setting

Sabale

Bodegård

Sundström

et al. 2015

Primary Care Diabetes

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“…The ADA, AGS, and Eighth Joint National Committee (JNC 8) provide recommendations regarding benefits of BP-lowering therapy in older adults, emphasizing that goals should be tailored to individual patient characteristics in order to minimize risk for harm (1,23,51) ( Table 1). The majority of these recommendations are based on studies focusing on systolic blood pressure (SBP); however, there is evidence that intensive control of diastolic blood pressure (DBP) can be also be associated with harm in older adults with diabetes (52,53). In one study of .34,000 subjects (aged 64.2 6 12.1 years) with T2D without known CVD at baseline followed for 11 years, an increase in ASCVD events was observed with low as well as high DBP in the older subgroup, with the lowest risk observed with DBP of 80-90 mmHg (53).…”

Section: Bpmentioning

confidence: 99%

Management of Atherosclerotic Cardiovascular Disease Risk Factors in the Older Adult Patient With Diabetes

Korytkowski

Forman

2017

Diabetes Care

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Older adults with diabetes are at higher risk for atherosclerotic cardiovascular disease (ASCVD) than younger adults with diabetes and older adults without diabetes. The rationale to implement ASCVD risk-lowering therapies in older adults with diabetes is compelling. Recommendations for lifestyle modification, lipidlowering therapy, blood pressure management, blood glucose control, and aspirin therapy are often based on studies that show their efficacy in younger populations. However, the risks associated with each of these interventions increase with age, and favorable risk-to-benefit ratios demonstrated in younger adults with diabetes are less certain in older populations. The variability in health status among older adults is pertinent. Those with robust health are more likely to tolerate and derive benefit from many therapies when compared with those who have more complex health including frailty. Age-and/or frailty-stratified data to help clarify these relationships are sparse. In this Perspective, current recommendations for modifying ASCVD risk are described with a review of the pertinent literature that guides their application in older adults. A pragmatic approach to the treatment of ASCVD risk factors in older adults with diabetes is presented.Diabetes is highly prevalent in the aging population, affecting .25% of individuals aged .65 years and 19% of those aged .75 years (1,2). Physiological changes associated with aging increase susceptibility to coronary heart disease and other atherosclerotic cardiovascular disease (ASCVD) processes (3). The incidence and prevalence of ASCVD-related macrovascular events essentially doubles in older adults with diabetes (4-6). The overlap of older age, diabetes, and other ASCVD risk factors enhances risk for microvascular and macrovascular complications, functional disability, and geriatric syndromes (including frailty, multimorbidity, polypharmacy, cognitive impairment, depression, urinary incontinence, and falls) (1,7-10). As the population of older adults grows, the implications of diabetes on ASCVD risk escalate, and insights regarding optimal care become increasingly important (2).Therapies directed at ASCVD risk factor reduction are important therapeutic priorities for older adults with diabetes as a way of modifying risk for vascular events and improving health-related quality of life (HRQL) (11,12). Therapeutic targets include control of lipids, blood pressure (BP), and blood glucose in combination with antiplatelet agents. The expectation is that these therapies will increase longevity, reduce ASCVD events and need for hospitalizations, and improve HRQL. However, iatrogenic risks and limited life expectancy confound these objectives

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Blood pressure levels and risk of cardiovascular events and mortality in type-2 diabetes

Abstract: In a large primary care-based sample of patients with type-2 diabetes, associations of SBP and DBP with risk of major cardiovascular events and mortality were U-shaped. This may have implications for risk stratification of persons with diabetes.

Cited by 43 publications

References 26 publications

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

Healthcare utilization and costs following newly diagnosed type-2 diabetes in Sweden: A follow-up of 38,956 patients in a clinical practice setting

Management of Atherosclerotic Cardiovascular Disease Risk Factors in the Older Adult Patient With Diabetes

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