Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease:
national population based cohort study
Samuel Adamsson Eryd,1,2,3 So a Gudbjörnsdottir,1,2 Karin Manhem,2 Annika Rosengren,2,3 Ann-Marie Svensson,1 Mervete Mi araj,1 Stefan Franzén,1 Sta an Björck1
To compare the risk associated with systolic blood pressure that meets current recommendations (that is, below 140 mm Hg) with the risk associated with lower levels in patients who have type 2 diabetes and no previous cardiovascular disease.
Population based cohort study with nationwide clinical registries, 2006-12. The mean follow-up was 5.0 years.
861 Swedish primary care units and hospital outpatient clinics.
187 106 patients registered in the Swedish national diabetes register who had had type 2 diabetes for at least a year, age 75 or younger, and with no previous cardiovascular or other major disease.
MAIN OUTCOME MEASURES
Clinical events were obtained from the hospital discharge and death registers with respect to acute myocardial infarction, stroke, a composite of acute myocardial infarction and stroke (cardiovascular disease), coronary heart disease, heart failure, and total mortality. Hazard ratios were estimated for di erent levels of baseline systolic blood pressure with clinical characteristics and drug prescription data as covariates.
The group with the lowest systolic blood pressure (110-119 mm Hg) had a signi cantly lower risk of non-fatal acute myocardial infarction (adjusted hazard ratio 0.76, 95% con dence interval 0.64 to 0.91; P=0.003), total acute myocardial infarction (0.85, 0.72 to 0.99; P=0.04), non-fatal cardiovascular disease (0.82, 0.72 to 0.93; P=0.002), total cardiovascular disease (0.88, 0.79 to 0.99; P=0.04), and non-fatal coronary heart disease (0.88, 0.78 to 0.99; P=0.03) compared with the reference group (130-139 mm Hg). There was no indication of a J shaped relation between systolic blood pressure and the endpoints, with the exception of heart failure and total mortality.
Lower systolic blood pressure than currently recommended is associated with signicantly lower risk of cardiovascular events in patients with type 2 diabetes. The association between low blood pressure and increased mortality could be due to concomitant disease rather than antihypertensive treatment.