Cardiovascular disease modifies the relationship between systolic blood pressure and outcomes in people with diabetes

Anping Cai; Jiabin Wang; Xiaoxuan Feng; Gianfranco Parati; Ji-Guang Wang; Yingqing Feng; Zhiqiang Nie

doi:10.1016/j.diabres.2024.111909

Cardiovascular disease modifies the relationship between systolic blood pressure and outcomes in people with diabetes

Diabetes Res Clin Pract. 2024 Oct 30:218:111909. doi: 10.1016/j.diabres.2024.111909. Online ahead of print.

Authors

Anping Cai¹, Jiabin Wang², Xiaoxuan Feng¹, Gianfranco Parati³, Ji-Guang Wang⁴, Yingqing Feng⁵, Zhiqiang Nie⁶

Affiliations

¹ Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China.
² Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China; Department of Epidemiology, Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Sothern Medical University, Guangzhou 510080, China.
³ Department of Cardiology, IRCCS, Ospedale San Luca, Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
⁴ The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁵ Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China. Electronic address: fengyingqing@gdph.org.cn.
⁶ Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China; Department of Epidemiology, Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Sothern Medical University, Guangzhou 510080, China. Electronic address: niezhiqiang@gdph.org.cn.

PMID: 39481649
DOI: 10.1016/j.diabres.2024.111909

Abstract

Objective: We aimed to evaluate the influences of cardiovascular disease (CVD) on the relationship between baseline systolic blood pressure (SBP) and outcomes in community populations with diabetes.

Methods: This is an observational study of 16,431 community adults with diabetes. The relationship between SBP with major adverse cardiovascular event (MACE) and all-cause death were evaluated using multivariable-adjusted Cox proportional hazard models and restricted cubic spline.

Results: After a median follow-up of 3.4 (IQR 2.6, 4.3) years, 2145 (13.1 %) MACE and 1025 (6.2 %) all-cause death occurred. In participants free of CVD, in reference to SBP < 120 mmHg group, the risks for MACE increased as SBP category (120-129, 130-139, and ≥ 140 mmHg) advanced (P-trend < 0.001), and there was a linear relationship (P-nonlinear = 0.75). The risks for all-cause death were lower in SBP of 120-139 mmHg and 140-159 mmHg groups but higher in SBP ≥ 160 mmHg group, and there was a U-shaped relationship (P-nonlinear < 0.001). In participants with existing CVD the relationship between baseline SBP with MACE and all-cause death did not show any specific pattern.

Conclusion: Results of the current study suggest that the relationship between baseline SBP with MACE and all-cause death varied significantly by baseline CVD status.

Keywords: Cardiovascular event; Diabetes; Mortality; Systolic blood pressure.