Abstract 11105: New Blood Pressure Control Target for Diabetic Patients of 140/90 mmHg is Confirmed by the JPAD Trial
Introduction: In 2013, the blood pressure (BP) control target for diabetic patients was changed in USA and Europe; however, there was a paucity of supporting evidence.
Hypothesis: We investigated whether 140/90 mmHg or 130/80 mmHg was a better BP control target.
Methods: We followed the cohort of 2536 Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) patients from May 2002 to July 2013, a median of 8.3 years. Primary end points were ischemic heart disease, stroke, peripheral arterial disease, or sudden death. BP of the JPAD patients was recorded on average 6 times. Based on the mean value of BP, we divided the patients into two groups: a high 140 BP (H140) group (n=674; systolic BP≥140 mmHg or diastolic BP≥90 mmHg or both); or, a low 140 BP (L140) group (n=1862; systolic BP<140 mmHg and diastolic BP<90 mmHg). We re-divided the patients into two groups: a high 130 BP (H130) group (n=1706); or, a low 130 BP (L130) group (n=830). We also established a middle 130-140 BP (M130-140) group (n=1032=2536-674-830) that consisted of the patients that excluded the H140 and L130 groups from the JPAD cohort.
Results: The incidence of primary end points was significantly higher in the H140 group than in the L140 group (P<0.0001, Figure). The incidence of the end points was higher in the H130 group than in the L130 group (P=0.0423, Figure). Cox proportional hazards model analysis revealed that BP (140/90) was an independent factor among significant factors (P<0.0001) and that BP (130/80) was barely independent (P=0.0423).
In the comparison among the three groups (H140, M130-140, L130), the incidence of the end points was significantly higher in the H140 group than in the L130 group (HR 1.85, Figure). There was no significant difference between the M130-140 and the L130 groups (HR 0.97, Figure).
Conclusions:Utilizing the JPAD cohort, this study serves to validate the guidelines in USA and Europe. 140/90 mmHg is a significantly better BP control target for diabetics.
Author Disclosures: H. Soejima: None. T. Morimoto: Other Research Support; Significant; Bayer. Honoraria; Modest; Kowa, Pfizer. S. Okada: None. M. Sakuma: None. M. Nakayama: None. S. Uemura: None. M. Kanauchi: None. N. Doi: None. H. Jinnouchi: None. S. Sugiyama: None. M. Waki: None. Y. Saito: Other Research Support; Significant; MSD, Mitsubishi Tanabe, Daiichi Sankyo, Takeda, Novartis, Shionogi, Astellas, AstraZeneca, Otsuka, St. Jude Medical, Kyowa Hakko Kirin. Honoraria; Modest; MSD, Mitsubishi Tanabe, Takeda, Daiichi Sankyo, Otsuka, Pfizer. Consultant/Advisory Board; Modest; Ono. H. Ogawa: Other Research Support; Modest; AstraZeneca, Astellas, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo, Kowa, MDS, Novartis, Pfizer, Sanofi, Takeda. Other Research Support; Significant; Bayer, Chugai, Otsuka. Honoraria; Modest; AstraZeneca, Bayer, Pfizer, Sanofi, Takeda. Honoraria; Significant; Daiichi Sankyo, MSD.
- © 2014 by American Heart Association, Inc.