What is the clinical evidence from this study?

Study design: Cohort. Population: Elevated blood pressure and impaired glucose metabolism (n=2004). Intervention: Blood pressure 130-139/80-89 mmHg with diabetes vs. Blood pressure < 130/80 mmHg with normoglycemia. Primary outcome: All-cause mortality (HR 3.30, 95% CI 1.48-7.38, p=<0.01).

December 21, 2023Open Access

Long-term effects of blood pressure 130–139/80–89 mmHg on all-cause and cardiovascular mortality among Chinese adults with different glucose metabolism

Q: What are the key findings of this study?

A blood pressure of 130-139/80-89 mmHg significantly increased the risk of all-cause mortality (HR 3.30) and cardiovascular mortality (HR 9.60) in Chinese adults with diabetes compared to normoglycemic individuals with BP < 130/80 mmHg.

Key Result

A blood pressure of 130-139/80-89 mmHg significantly increased the risk of all-cause mortality (HR 3.30) and cardiovascular mortality (HR 9.60) in Chinese adults with diabetes compared to normoglycemic individuals with BP < 130/80 mmHg.

Study Design

Type

Cohort (n=2,004)

Multicenter

Yes

Structured PICO

Does a blood pressure of 130-139/80-89 mmHg increase the risk of all-cause and cardiovascular mortality in Chinese adults with different glucose metabolism?

Population

2,004 Chinese adults from a prospective population-based cohort in Shanghai, with different glucose metabolism categories.

Intervention

Blood pressure 130-139/80-89 mmHg

Comparator

Blood pressure < 130/80 mmHg

Outcome

All-cause and cardiovascular mortalityhard clinical

A blood pressure of 130-139/80-89 mmHg is associated with significantly higher all-cause and cardiovascular mortality in Chinese adults with diabetes, supporting a target BP < 130/80 mmHg for this population.

Main Result

Effect estimate: HR 3.30 (95% CI 1.48-7.38)

Absolute Event Rate: 18.3% vs 3.1%

p-value: p=<0.01

Limitations

Not all participants underwent a baseline HbA1c test in 2002, potentially missing some diabetes cases.
Used office BP measurements instead of 24-hour ambulatory BP monitoring.
Relatively small sample size and relatively young participants, leading to low death numbers in certain subgroups.
Serum creatinine and urinary albumin levels were not measured at baseline.
The study is solely observational in nature.

Abstract

BACKGROUND: This study aimed to investigate the risks of all-cause and cardiovascular mortality associated with blood pressure (BP) levels of 130-139/80-89 mmHg in Chinese adults with different glucose metabolism, during a long-term follow-up of over 20 years. METHODS: A prospective population-based cohort of 2,132 adults in Shanghai was established in 2002 and followed for 21 years. The association between BP categories and mortality was assessed, and the risk was further analyzed using multiple Cox regression analysis by combining BP and blood glucose categories. RESULTS: The final analysis included 2,004 participants, with 397 all-cause and 166 cardiovascular mortality. The incidence of all-cause and cardiovascular mortality per 1,000 person-years for different BP categories were as follows: BP < 130/80 mmHg (4.5 and 1.3), 130-139/80-89 mmHg (7.7 and 2.9), and ≥ 140/90 mmHg or treated groups (19.9 and 8.7), respectively. After adjusting for age, sex, and other factors, BP ≥ 140/90 mmHg was significantly associated with a higher risk of mortality across different blood glucose categories. However, using BP < 130/80 mmHg and normoglycemia as the reference, a BP of 130-139/80-89 mmHg was significantly associated with higher risks of all-cause (hazard ratio 3.30 95% confidence interval 1.48-7.38, P < 0.01) and cardiovascular mortality (9.60 1.93-47.7, P < 0.01) in diabetes, but not in those with normoglycemia or prediabetes. CONCLUSIONS: BP of 130-139/80-89 mmHg may lead to a significantly higher risk of all-cause and cardiovascular mortality in Chinese adults with diabetes, but not in those with normoglycemia or prediabetes. This suggests that the targeted BP for people with diabetes should be < 130-139/80-89 mmHg.

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