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Article: Effect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Population-Based Retrospective Cohort Study

TitleEffect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Population-Based Retrospective Cohort Study
Authors
Issue Date2018
Citation
Diabetes Care, 2018, v. 41, p. 1134-1141 How to Cite?
AbstractOBJECTIVE: The objective of this study was to compare the incidence of cardiovascular disease (CVD) among patients with type 2 diabetes mellitus (T2DM) with treated hypertension who achieved systolic blood pressures (SBPs) of <120, <130, and <140 mmHg after an increase in their antihypertensive regimen. RESEARCH DESIGN AND METHODS: A retrospective cohort study was conducted on 28,014 primary care adult patients with T2DM with no prior diagnosis of CVD and who achieved SBP readings <140 mmHg after an increase in the number of antihypertensive medications prescribed. Using an extension of propensity score matching, a total of 2,079, 10,851, and 15,084 matched patients with achieved SBP measurements of <120, <130, and <140 mmHg were identified. The association between achieved SBP and incident CVD were evaluated using Cox regressions. Subgroup analyses were conducted by stratifying patients' baseline characteristics. RESULTS: Over a median follow-up period of 4.8 years, the incidence of CVD in patients with achieved SBP measures of <120, <130, and <140 mmHg were 318 (15.3%; incidence rate [IR] 34.3/1,000 person-years [PY]), 992 (9.1%; IR 20.4/1,000 PY), and 1,635 (10.8%; IR 21.4/1,000 PY). Achieved SBP <120 mmHg was associated with a higher risk of CVD compared with achieved SBP <130 mmHg (hazard ratio [HR] 1.75 [95% CI 1.53, 2.00]) and achieved SBP <140 mmHg (HR 1.67 [95% CI 1.46, 1.90]). There was a significant reduction in CVD risk in patients <65 years (HR 0.81 [95% CI 0.69, 0.96]) but no difference for other patients, including patients ≥65 years, who achieved SBP <130 mmHg when compared with the group that achieved SBP <140 mmHg. CONCLUSIONS: Our findings support a SBP treatment target of 140 mmHg and suspect no risk reduction attenuation on CVD for lower SBP targets (<120 or <130 mmHg) for most patients with uncomplicated T2DM. A randomized control trial is still needed to confirm these findings.
Persistent Identifierhttp://hdl.handle.net/10722/254630

 

DC FieldValueLanguage
dc.contributor.authorWan, YF-
dc.contributor.authorYu, YTE-
dc.contributor.authorChin, WY-
dc.contributor.authorFung, SCC-
dc.contributor.authorFong, DYT-
dc.contributor.authorChoi, PH-
dc.contributor.authorChan, KC-
dc.contributor.authorLam, CLK-
dc.date.accessioned2018-06-21T01:03:40Z-
dc.date.available2018-06-21T01:03:40Z-
dc.date.issued2018-
dc.identifier.citationDiabetes Care, 2018, v. 41, p. 1134-1141-
dc.identifier.urihttp://hdl.handle.net/10722/254630-
dc.description.abstractOBJECTIVE: The objective of this study was to compare the incidence of cardiovascular disease (CVD) among patients with type 2 diabetes mellitus (T2DM) with treated hypertension who achieved systolic blood pressures (SBPs) of <120, <130, and <140 mmHg after an increase in their antihypertensive regimen. RESEARCH DESIGN AND METHODS: A retrospective cohort study was conducted on 28,014 primary care adult patients with T2DM with no prior diagnosis of CVD and who achieved SBP readings <140 mmHg after an increase in the number of antihypertensive medications prescribed. Using an extension of propensity score matching, a total of 2,079, 10,851, and 15,084 matched patients with achieved SBP measurements of <120, <130, and <140 mmHg were identified. The association between achieved SBP and incident CVD were evaluated using Cox regressions. Subgroup analyses were conducted by stratifying patients' baseline characteristics. RESULTS: Over a median follow-up period of 4.8 years, the incidence of CVD in patients with achieved SBP measures of <120, <130, and <140 mmHg were 318 (15.3%; incidence rate [IR] 34.3/1,000 person-years [PY]), 992 (9.1%; IR 20.4/1,000 PY), and 1,635 (10.8%; IR 21.4/1,000 PY). Achieved SBP <120 mmHg was associated with a higher risk of CVD compared with achieved SBP <130 mmHg (hazard ratio [HR] 1.75 [95% CI 1.53, 2.00]) and achieved SBP <140 mmHg (HR 1.67 [95% CI 1.46, 1.90]). There was a significant reduction in CVD risk in patients <65 years (HR 0.81 [95% CI 0.69, 0.96]) but no difference for other patients, including patients ≥65 years, who achieved SBP <130 mmHg when compared with the group that achieved SBP <140 mmHg. CONCLUSIONS: Our findings support a SBP treatment target of 140 mmHg and suspect no risk reduction attenuation on CVD for lower SBP targets (<120 or <130 mmHg) for most patients with uncomplicated T2DM. A randomized control trial is still needed to confirm these findings.-
dc.languageeng-
dc.relation.ispartofDiabetes Care-
dc.titleEffect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Population-Based Retrospective Cohort Study-
dc.typeArticle-
dc.identifier.emailWan, YF: yfwan@hku.hk-
dc.identifier.emailYu, YTE: ytyu@hku.hk-
dc.identifier.emailChin, WY: chinwy@hku.hk-
dc.identifier.emailFong, DYT: dytfong@hku.hk-
dc.identifier.emailChoi, PH: ephchoi@hku.hk-
dc.identifier.emailLam, CLK: clklam@hku.hk-
dc.identifier.authorityYu, YTE=rp01693-
dc.identifier.authorityChin, WY=rp00290-
dc.identifier.authorityFung, SCC=rp01330-
dc.identifier.authorityFong, DYT=rp00253-
dc.identifier.authorityChoi, PH=rp02329-
dc.identifier.authorityLam, CLK=rp00350-
dc.identifier.doi10.2337/dc17-2443-
dc.identifier.hkuros285431-
dc.identifier.volume41-
dc.identifier.spage1134-
dc.identifier.epage1141-

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