Key result
Lower baseline systolic blood pressure was associated with a higher risk of death (HR 1.13 per 10 mmHg lower SBP) in patients with type 2 diabetes and a recent coronary event who had additional cardiovascular disease, but not in those with only the index event.
Why the study?
The relationship between blood pressure and mortality in type 2 diabetes is controversial, with concern for increased risk associated with excessively lowered blood pressure.
Does baseline blood pressure level predict all-cause mortality in patients with type 2 diabetes and a recent acute coronary syndrome, and is this modified by prior cardiovascular disease?
Observational (n=5,852)
Yes
Does baseline blood pressure level predict all-cause mortality in patients with type 2 diabetes and a recent acute coronary syndrome, and is this modified by prior cardiovascular disease?
Answers are grounded in this paper and cite their sources.
In patients with type 2 diabetes and a recent acute coronary syndrome, lower blood pressure is associated with increased mortality only in those with a history of additional cardiovascular disease.
BACKGROUND: The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure. METHODS: We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization. RESULTS: Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99-1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04-1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86-1.04) P = 0.26; P for interaction 0.005). CONCLUSIONS: The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration. Trial registration ClinicalTrials.gov number NCT01147250, first posted June 22, 2010.
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Wijkman et al. (2020) conducted an observational in Type 2 diabetes and a recent acute coronary syndrome (n=5,852). Lower baseline systolic blood pressure vs. Higher baseline systolic blood pressure was evaluated on All-cause mortality (overall association per 10 mmHg lower systolic blood pressure) (HR 1.05, 95% CI 0.99-1.12, p=0.10). Lower baseline systolic blood pressure was associated with a higher risk of death (HR 1.13 per 10 mmHg lower SBP) in patients with type 2 diabetes and a recent coronary event who had additional cardiovascular disease, but not in those with only the index event.
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