Abstract MP71: Aggressive Blood Pressure Control increased Cardiovascular Heart disease Risk in the Diabetic Patients among Louisiana
Background: Blood pressure control can reduce the risk of coronary heart disease (CHD) among diabetic patents, however, it is not known if the lowest risk of CHD is among diabetic patients with the lowest blood pressure level.
Aim: To investigate the race-specific association of different levels of blood pressure with CHD risk among patients with type 2 diabetic in the Louisiana State University Hospital-based Longitudinal study (LSUHLS).
Methods: We performed a prospective cohort study (2000-2009) on diabetic patients enrolled in the LSUHLS. The study sample included 17,536 African American diabetic patients and 12,618 White diabetic patients. Cox proportional hazards regression models were used to estimate the association of different levels of blood pressure at baseline and during follow-up with CHD risk after adjustment for age, sex, smoking, income, type of insurance, body mass index, glycosylated hemoglobin, low-density lipoprotein cholesterol, use of antihypertensive drugs, use of diabetes medications, and use of cholesterol-lowering agents.
Results: During a mean follow up of 7.09 years, 7,260 CHD incident cases were identified. The multivariable-adjusted hazard ratios (HRs) of CHD associated with different level of systolic blood pressure at baseline (<110, 110-119, 120-129, 130-139 [reference group], 140-159, and ≥160 mmHg) were 1.28 (95% confidence interval [CI] 1.08-1.53), 1.09 (0.94-1.27), 1.03 (0.91-1.17), 1.00, 1.03 (0.93-1.13), and 1.09 (0.99-1.21) (P trend = 0.057) for African American diabetic patients, and 1.54 (1.32-1.79), 1.15 (1.01-1.31), 1.06 (0.94-1.19), 1.00, 0.97 (0.88-1.07), and 1.00 (0.90-1.12) (P trend<0.001) for white diabetic patients, respectively. A significantly increased risk of CHD was observed among both African American and White participants with SBP<120 mmHg. A U-shaped association of diastolic blood pressure or joint group of both systolic and diastolic blood pressure with CHD risk was observed among both African American and White diabetic patients (all P trend<0.001). When stratified by age, this U-shaped association of blood pressure with CHD was present in subject aged 30-49 years, 50-59 years, and 60-94 years. When we used an updated mean of blood pressure, or included only diabetic patients using antihypertensive drugs, the U-shaped association of blood pressure with CHD risk did not change.
Conclusions: The current study suggests that aggressive blood pressure control (i.e., SBP<120 mmHg and/or DBP<70 mmHg) is associated with an increased risk of CHD among both black and white Louisiana patients with diabetes.
- © 2013 by American Heart Association, Inc.