Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2016 Aug 4:354:i4070.
doi: 10.1136/bmj.i4070.

Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study

Samuel Adamsson Eryd  1 , Soffia Gudbjörnsdottir  2 , Karin Manhem  3 , Annika Rosengren  4 , Ann-Marie Svensson  5 , Mervete Miftaraj  5 , Stefan Franzén  5 , Staffan Björck  5
Affiliations
Comparative Study

Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study

Samuel Adamsson Eryd et al. BMJ. .

Abstract

Objectives: To compare the risk associated with systolic blood pressure that meets current recommendations (that is, below 140 mm Hg) with the risk associated with lower levels in patients who have type 2 diabetes and no previous cardiovascular disease.

Design: Population based cohort study with nationwide clinical registries, 2006-12. The mean follow-up was 5.0 years.

Setting: 861 Swedish primary care units and hospital outpatient clinics.

Participants: 187 106 patients registered in the Swedish national diabetes register who had had type 2 diabetes for at least a year, age 75 or younger, and with no previous cardiovascular or other major disease.

Main outcome measures: Clinical events were obtained from the hospital discharge and death registers with respect to acute myocardial infarction, stroke, a composite of acute myocardial infarction and stroke (cardiovascular disease), coronary heart disease, heart failure, and total mortality. Hazard ratios were estimated for different levels of baseline systolic blood pressure with clinical characteristics and drug prescription data as covariates.

Results: The group with the lowest systolic blood pressure (110-119 mm Hg) had a significantly lower risk of non-fatal acute myocardial infarction (adjusted hazard ratio 0.76, 95% confidence interval 0.64 to 0.91; P=0.003), total acute myocardial infarction (0.85, 0.72 to 0.99; P=0.04), non-fatal cardiovascular disease (0.82, 0.72 to 0.93; P=0.002), total cardiovascular disease (0.88, 0.79 to 0.99; P=0.04), and non-fatal coronary heart disease (0.88, 0.78 to 0.99; P=0.03) compared with the reference group (130-139 mm Hg). There was no indication of a J shaped relation between systolic blood pressure and the endpoints, with the exception of heart failure and total mortality.

Conclusions: Lower systolic blood pressure than currently recommended is associated with significantly lower risk of cardiovascular events in patients with type 2 diabetes. The association between low blood pressure and increased mortality could be due to concomitant disease rather than antihypertensive treatment.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 Enrolment of participants in study of blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease
None
Fig 2 Kaplan-Meier analysis of non-fatal cardiovascular events, showing proportion of patients with events (composite of nonfatal myocardial infarction or stroke) in different systolic blood pressure groups
None
Fig 3 Hazard ratios in various systolic blood pressure groups for outcomes of non-fatal AMI (acute myocardial infarction), total AMI, non-fatal stroke, total stroke, non-fatal CVD (cardiovascular disease), total CVD, non-fatal CHD (coronary heart disease), total CHD, heart failure, and total mortality
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Mancia G, Fagard R, Narkiewicz K, et al. Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-357. 10.1097/01.hjh.0000431740.32696.cc pmid:23817082. - DOI - PubMed
    1. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-20. 10.1001/jama.2013.284427 pmid:24352797. - DOI - PubMed
    1. American Diabetes Association. Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers. Clin Diabetes 2016;34:3-21. 10.2337/diaclin.34.1.3 pmid:26807004. - DOI - PMC - PubMed
    1. Swedish National Diabetes Register. 20 years of successful improvements. 2016. https://www.ndr.nu/pdfs/20%20years%20of%20successful%20improvements_lowr...
    1. Tancredi M, Rosengren A, Svensson AM, et al. Excess Mortality among Persons with Type 2 Diabetes. N Engl J Med 2015;373:1720-32. 10.1056/NEJMoa1504347 pmid:26510021. - DOI - PubMed

Publication types