OBJECTIVE Blood pressure ranges associated with cardiovascular disease (CVD) events in
May 17, 2017
OBJECTIVE Blood pressure ranges associated with cardiovascular disease (CVD) events in advanced type 2 diabetes are not clear. and On-Study were analyzed to detect associations with CVD risk. The primary outcome was the time from randomization to the first occurrence of myocardial infarction stroke congestive heart failure medical procedures for vascular disease inoperable coronary disease amputation for ischemic gangrene or CVD death. RESULTS Separated SBP ≥140 mmHg had significant risk at baseline (hazards ratio [HR] 1.508 < 0.001) and On-Study (HR 1.469 = 0.002). DBP <70 mmHg increased CVD events at baseline (HR 1.482 < 0.001) and On-Study (HR 1.491 < 0.001). Combined blood pressure categories indicated high risk for CVD events for SBP ≥140 with DBP <70 mmHg at baseline (HR 1.785 = 0.03) and On-Study (HR 2.042 = 0.003) and nearly all SBP with DBP <70 mmHg. CONCLUSIONS Increased risk of CVD events with SBP ≥140 mmHg emphasizes the urgency for treatment of systolic hypertension. Increased risk with DBP <70 mmHg even when combined with SBP in guideline-recommended target ranges supports a new finding in patients with type 2 diabetes. The results emphasize that DBP <70 mmHg in these patients was associated with elevated CVD risk and may best be avoided. Based on results of recent interventional trials (1-3) the question of whether or not intensive glucose control significantly reduces the risk of cardiovascular disease (CVD) in all patients with type 2 diabetes remains controversial. It may be beneficial in subgroups of these Brefeldin A patients when severe hypoglycemia is usually avoided. Blood pressure (BP) control is usually consistently correlated with CVD events in studies of risk factors in type 2 diabetes. In the UK Prospective Diabetes Study BP control was twice as effective as glucose control in stopping any diabetes end points (4 5 The Hypertension Optimal Treatment (HOT) study and the Appropriate Blood Pressure Control in Diabetes (ABCD) trial support improved BP control as a significant CVD event preventive factor in patients with diabetes (6-8). Both the American Diabetes Association (ADA) and the Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure (JNC-7) recommend treatment of BP in patients with diabetes Brefeldin A to a target of <130/<80 mmHg (9 10 Current evidence supports a systolic blood pressure (SBP) level of <140 mmHg but there is sparse information to guide physicians as to how far the SBP and diastolic blood pressure (DBP) can be lowered safely and whether lower BP levels might be associated with increased risk. We analyzed the BP data Brefeldin A collected during the Veterans Affairs Diabetes Trial (VADT) to learn whether specific levels of BP in patients with type 2 diabetes predict CVD events. The VADT is usually a 20-center 1 791 prospective study of intensive versus standard glucose treatment in patients with suboptimal responses to maximum oral brokers or insulin. The main objective was to assess the benefit of intensive glucose control for up to 7 years on CVD Brefeldin A events in patients with advanced type 2 diabetes. Other objectives included the assessment of the effects on microvascular and neurological complications cognitive function quality of life and cost-effectiveness. BP lipids diet and lifestyle were treated identically in both arms. By improving BP control in an identical manner in both glucose arms VADT excluded the effect CACNG6 of BP differences in CVD events between treatment arms and reduced the overall risk of macrovascular complications during the trial. The initial results were published recently (1). RESEARCH DESIGN AND METHODS Randomization for VADT began in 2000. In all 1 791 individuals were included in the study. The design of VADT and the results have been reported elsewhere (1 11 Baseline characteristics of subjects Brefeldin A are detailed in supplementary Table 1 (available in an online appendix at http://care.diabetesjournals.org/cgi/content/full/dc10-1420/DC1). All who inserted the trial with brand-new or treated hypertension received stepped treatment to keep BP below 130/80 mmHg. After you start with ACE inhibitors or angiotensin II receptor blockers the next.