Key result
In older patients with diabetes, blood pressure had a U-curved association with cardiovascular events (incidence 26.62 per 1000 person-years), with a nadir at 120-129/65-69 mm Hg.
Why the study?
Blood pressure targets in elderly patients with diabetes remain unclear.
What is the optimal blood pressure target to prevent cardiovascular events in older patients with diabetes?
Cohort (n=225,563)
What is the optimal blood pressure target to prevent cardiovascular events in older patients with diabetes?
In older patients with diabetes, both high (≥140/95 mm Hg) and low (<120/65 mm Hg) blood pressures are associated with an increased risk of cardiovascular events, demonstrating a U-shaped relationship.
Should not yet change BP targets in elderly diabetes without CVD; leaves open RCT confirmation of a mid-range nadir.
Background Blood pressure (BP) targets in elderly patients with diabetes remain unclear. We evaluated the association between BP and cardiovascular disease in elderly patients with diabetes without cardiovascular disease or heart failure. Methods and Results We performed a retrospective cohort study of 225 563 elderly (aged ≥65 years) patients with diabetes without cardiovascular disease or heart failure from 2009 to 2017 using the National Health Information Database. We divided the participants by systolic BP (SBP) and diastolic BP. Primary composite outcomes were stroke, myocardial infarction, heart failure, and all‐cause death analyzed by Cox proportional hazards regression analysis adjusted for baseline covariates. During a median follow‐up of 7.76 years, the incidence rate of primary composite outcomes was 26.62 per 1000 person‐years. In multivariable Cox proportional hazard modeling, the risk of the primary outcome had a U‐curved association with SBP/diastolic blood pressure with a nadir between 120 and 129 mm Hg/65 and 69 mm Hg, respectively. Hypertension medication was associated with lower risk of primary composite outcomes in SBP ≥140 mm Hg ( P for interaction for SBP <0.001) and diastolic blood pressure ≥90 mm Hg ( P for interaction for diastolic blood pressure=0.018). In participants aged ≥80 years, SBP ≥160 mm Hg was only a marginally higher risk for primary composite outcomes (hazard ratio=1.11; 95% CI, 0.98–1.24). Conclusions In this large sample of older Korean patients with diabetes, cardiovascular events were more common in people with resting SBP or diastolic BP ≥140 or 95 mm Hg, respectively, and also more common in people with resting SBP or diastolic BP <120 or 65 mm Hg, respectively.
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A 2021 study conducted a cohort in diabetes without cardiovascular disease or heart failure (n=225,563). Blood pressure vs. 120-129/65-69 mm Hg (nadir) was evaluated on stroke, myocardial infarction, heart failure, and all-cause death. In older patients with diabetes, blood pressure had a U-curved association with cardiovascular events (incidence 26.62 per 1000 person-years), with a nadir at 120-129/65-69 mm Hg.
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