New European blood pressure targets for diabetes may put patients at risk
Recently raised systolic blood pressure targets for people with diabetes may put them at elevated risk for stroke and myocardial infarction, study data show.
In February 2015, the Swedish National Board of Health and Welfare raised the systolic BP targets from below 130 mm Hg to below 140 mm Hg for patients with diabetes, according to a press release.
“We believe that the recommendation to accept higher BP in patients with diabetes is incorrect,” Staffan Björck, MD, PhD, associate professor of nephrology at Sahlgranska Academy in Sweden, said in the release. “It may lead to more cases of stroke and myocardial infarction in this patient group.”
Björck and colleagues evaluated data from the Swedish national diabetes, hospital discharge, cause of death and prescribed drug registers from 2006 to 2012 on 187,106 adults with type 2 diabetes to determine the effect of the new systolic BP recommendation on risk for cardiovascular disease in patients without a history of the condition. Follow-up was conducted for a mean 5 years.
Participants were divided into groups based on their baseline systolic BP levels: 110 to 119 mm Hg (n = 12,829), 120 to 129 mm Hg (n = 36,618), 130 to 139 mm Hg (reference group; n = 49,518), 140 to 149 mm Hg (n = 43,687), 150 to 159 mm Hg (n = 21,558) and 160 mm Hg or greater (n = 22,896).
Overall, 6.5% of participants died during the study period, and 30% of the deaths were attributable to CV causes. Participants with the lowest baseline systolic BP had the highest rates of mortality from infection; diseases of the nervous, respiratory and digestive systems; and external causes of death and the lowest unadjusted risk for developing nonfatal CVD.
The risks for nonfatal acute MI (HR = 0.76; 95% CI, 0.64-0.91), total acute MI (HR = 0.85; 95% CI, 0.72-0.99), nonfatal CVD (HR = 0.82; 95% CI, 0.72-0.93), total CVD (HR = 0.88; 95% CI, 0.79-0.99) and nonfatal coronary heart disease (HR = 0.88; 95% CI, 0.78-0.99) were significantly lower among participants in the lowest BP group compared with those in the reference group.
“What we have seen in our study is that, if we exclude individuals with previous severe disease, then the connection between low BP and increased risk of stroke and myocardial infarction disappears,” study researcher Samuel Adamsson Eryd, MD, of the Centre of Registers Västra Götland in Sweden, said in the release. – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.