T2DM med njurpåv; lägst risk för CVD vid BT 135-139/72-74. NDR-utdata. Diabetologia

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T2DM med njurpåv; lägst risk för CVD vid BT 135-139/72-74. NDR-utdata. Diabetologia

Blood pressure level and risk of major cardiovascular events

and all-cause of mortality in patients with type 2 diabetes

and renal impairment: an observational study from the Swedish

National Diabetes Register. Diabetologia

Hanri Afghahi & Maria K. Svensson &

Mirnabi Pirouzifard & Björn Eliasson &

Ann-Marie Svensson

In conclusion, the risk of cardiovascular disease and allcause

mortality was very high in patients with type 2 diabetes

and RI in clinical practice, and increased significantly with

both high and low SBP and DBP in a U-shaped manner. A

SBP of 135–139 mmHg and a DBP of 72–74 mmHg were

associated with the lowest risks of CVE and all-cause

mortality.

Abstract

Aims/hypothesis We assessed the relationship between BP

and risk of cardiovascular events (CVEs) and all-cause mortality

in patients with type 2 diabetes and renal impairment

(estimated GFR<60 ml min−1 1.73 m−2) treated in clinical

practice.

Methods A total of 33,356 patients (aged 75±9 years, diabetes

duration of 10±8 years) with at least one serum creatinine

and BP value available in the Swedish National Diabetes

2011 or death. The relationships between mean BPs, CVEs

and all-cause mortality were examined using time-dependent

Cox models to estimate HRs, adjusting for cardiovascular risk

factors and ongoing medications.

Results During the follow-up period (mean 5.3 years), 11,317

CVEs and 10,738 deaths occurred. The lowest risks of CVEs

and all-causemortalitywere observedwith a systolic BP (SBP)

of 135–139 and a diastolic BP (DBP) of 72–74mmHg, and the

highest risks were observed for those with SBP intervals 80–

120 (CVE HR 2.3 [95% CI 2.0, 2.6] and all-cause mortality

HR 2.4, [95% CI 2.1, 2.7]) and 160–230 mmHg (CVE HR 3.0

[95%CI 2.6, 3.3] and all-cause mortality HR 2.0 [95% CI 1.8–

2.3]) and DBP intervals 40–63 mmHg (CVE HR 2.0 [95% CI

1.8, 2.2], all-cause mortality HR 2.0 [95% CI 1.8, 2.2]) and

83–125 mmHg (CVE HR 2.3 [95% CI 2.0, 2.5], all-cause

mortality HR 2.3 [95% CI 2.0, 2.6]).

Conclusions/interpretation In this nationwide cohort of patients

with type 2 diabetes and renal impairment, the risk of

CVEs and all-cause mortality increased significantly with

both high and low BPs, while an SBP of 135–139 mmHg

and DBP of 72–74 mmHg were associated with the lowest

risks of CVEs and death.

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