Key result
In patients with type 2 diabetes, systolic blood pressure of 130-139 mm Hg increased the risk of stroke (HR 1.15; 95% CI 1.12-1.18) and MI (HR 1.05; 95% CI 1.02-1.09) compared to 110-119 mm Hg.
Why the study?
The optimal blood pressure target to prevent the development of cardiovascular diseases in Korean subjects with type 2 diabetes mellitus remained unclear.
Does systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg increase the risk of cardiovascular disease in Korean patients with type 2 diabetes mellitus?
Cohort (n=2,262,725)
Does systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg increase the risk of cardiovascular disease in Korean patients with type 2 diabetes mellitus?
Hazard Ratio: 1.15 (95% CI 1.12–1.18)
In Korean patients with type 2 diabetes, blood pressure ≥130/80 mm Hg is associated with an increased risk of cardiovascular events, supporting a lower BP target in this population.
Raises stroke risk at SBP 130-139 mm Hg; supports lowering treatment thresholds in hypertension guidelines.
The objective of this study was to investigate the optimal blood pressure (BP) target to prevent development of cardiovascular diseases (CVDs) in Korean subjects with type 2 diabetes mellitus. Using the Korean National Health Insurance Service database, 2 262 725 subjects with type 2 diabetes mellitus who underwent regular health checks between 2009 and 2012 were included. Subjects with previous CVDs were excluded. Participants were grouped by 10-mm Hg intervals of observed systolic BP (SBP) by 5-mm Hg intervals of diastolic BP. There were 124 466 deaths (5.50%), 67 235 cases of stroke (2.97%), and 41 726 myocardial infarctions (1.84%) during a median follow-up of 6.5 years. Compared with SBP 110 to 119 mm Hg, there was no increased risk among subjects with SBP 120 to 129 mm Hg, but SBP ≥130 mm Hg was associated with a significant increase in the incidence of CVDs. SBP 130 to 139 mm Hg was associated with a significant increase in the incidence of stroke (hazard ratio, 1.15; 95% CI, 1.12-1.18) and myocardial infarctions (hazard ratio, 1.05; 95% CI, 1.02-1.09) compared with SBP 110 to 119 mm Hg. Subjects with diastolic BP 80 to 84 mm Hg had a higher risk of CVDs than subjects with diastolic BP 75 to 79 mm Hg. The overall relationship between BP and CVD risk was positive, with a greater strength observed for younger age groups. The optimal cutoff for Korean patients with type 2 diabetes mellitus associated with lower CVD risk may be 130 mm Hg for SBP or 80 mm Hg for diastolic BP.
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Kim et al. (2019) conducted a cohort in type 2 diabetes mellitus (n=2,262,725). Systolic blood pressure 130 to 139 mm Hg vs. Systolic blood pressure 110 to 119 mm Hg was evaluated on stroke (HR 1.15, 95% CI 1.12-1.18). In patients with type 2 diabetes, systolic blood pressure of 130-139 mm Hg increased the risk of stroke (HR 1.15; 95% CI 1.12-1.18) and MI (HR 1.05; 95% CI 1.02-1.09) compared to 110-119 mm Hg.