Early blood pressure control reduces future CV events in diabetes

By Andrew Czyzewski, medwireNews Reporter

Type 2 diabetes patients who fail to properly control their blood pressure within a year of being diagnosed with hypertension (HT) face an elevated risk for future major cardiovascular events (MACE) for up to 3 years subsequently, study results show.

As a result prompt control of new onset hypertension in patients with diabetes may provide important short-term clinical benefits.

Indeed, study co-author Patrick O'Connor (HealthPartners Research Foundation, Minneapolis, Minnesota, USA) and colleagues suggest that "insufficient attention has been devoted to the aggressive early management of blood pressure in patients with diabetes."

For the study the researchers recruited 15,665 patients aged an average of 51.5 years with Type 2 diabetes, but without diagnosed coronary or cerebrovascular disease at baseline, who met standard criteria for new-onset HT.

The latter was defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) as two consecutive elevated office blood pressure readings with systolic blood pressure (SBP) of 130 mmHg or higher and diastolic blood pressure (DBP) of 80 mmHg or higher.

At the start of the study the average blood pressure in patients was 136.8/80.8 mmHg.

Subsequently in the year after HT onset, mean blood pressure decreased to 131.4/78.0 mmHg and was less than 130/80 mmHg in 32.9% of patients and less than 140/90 mmHg in 80.2%.

After a mean follow-up of 3.2 years, age-adjusted rates of MACE in those patients with a 1-year blood pressure measurements of less than130/80, 130-139/80-89, and 140/90 mmHg or higher were 5.10, 4.27, and 6.94 events per 1000 person-years, respectively.

In statistical models adjusted for Framingham Risk Score (FRS) the rates of MACE were significantly higher in those with mean blood pressure of140/90mmHg or higher in the first year after HT onset (rate ratio [RR]=1.30).

Given that patients were relatively young at HT onset, important clinical effects detected after only 3 years of follow-up may become more pronounced over a longer follow-up period, O'Connor et al note.

They add that although the relative risk of cardiovascular events in relation to degree of HT control was similar across strata of FRS and microvascular diabetes complications, subgroups of diabetic patients with higher absolute baseline cardiovascular risks may benefit the most from early blood pressure control.

"Resolution of this issue is not possible in this study owing to limited power, so larger or longer studies are needed to fully resolve this clinical question," they comment in the journal Diabetes Care.

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