Key result
In patients with diabetes and hypertension, blood pressure < 120/70 mmHg was associated with a 15% lower risk of cardiovascular events compared to 130-139/80-89 mmHg (HR 0.85), primarily driven by patients aged < 70 years.
Why the study?
Little is known about age-specific target blood pressure to achieve the lowest cardiovascular risk in hypertensive patients with diabetes mellitus.
Does blood pressure < 120/70 mmHg reduce composite cardiovascular events in patients with diabetes mellitus and hypertension compared to blood pressure 130-139/80-89 mmHg?
Cohort (n=241,148)
Does blood pressure < 120/70 mmHg reduce composite cardiovascular events in patients with diabetes mellitus and hypertension compared to blood pressure 130-139/80-89 mmHg?
Hazard Ratio: 0.85 (95% CI 0.8–0.9)
Absolute Event Rate: 1212% vs 1399%
In diabetic patients with hypertension but no prior cardiovascular disease, lowering blood pressure to <120/70 mmHg reduces cardiovascular events in those under 70 years old, but offers no additional benefit and may increase mortality risk in those 70 years or older.
Supports age-specific BP targets in diabetic hypertension; hypothesis-generating for RCTs confirming thresholds by age.
BACKGROUND: Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age. METHODS: Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke. RESULTS: Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130-139/80-89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130-139/80-89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130-139/80-89 mmHg and BP 120-129/70-79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130-139/80-89 mmHg at all ages. CONCLUSIONS: In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130-139/80-89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130-139/80-89 mmHg at the age of ≥ 70.
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Kim et al. (2020) conducted a cohort in Hypertension and diabetes mellitus (n=241,148). Blood pressure < 120/70 mmHg vs. Blood pressure 130-139/80-89 mmHg was evaluated on Composite cardiovascular events (cardiovascular death, myocardial infarction, and stroke) (HR 0.85, 95% CI 0.80-0.90). In patients with diabetes and hypertension, blood pressure < 120/70 mmHg was associated with a 15% lower risk of cardiovascular events compared to 130-139/80-89 mmHg (HR 0.85), primarily driven by patients aged < 70 years.
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