Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish national diabetes register.
OBJECTIVE
To estimate risks of fatal/nonfatal coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with SBP in an observational study of patients with type 2 diabetes.


METHODS
Twelve thousand, six hundred and seventy-seven patients aged 30-75 years, treated with antihypertensive drugs, without previous congestive heart failure, followed for 5 years.


RESULTS
Risk curves of CHD and stroke increased progressively with higher baseline or updated mean SBP in a Cox model, in all participants, and in two subgroups without (n = 10 304) or with (n = 2373) a history of CVD, with no J-shaped risk curves at low SBP levels. Hazard ratios for CHD and stroke per 10-mmHg increase in updated mean SBP in all participants, adjusting for clinical characteristics and traditional risk factors, were 1.08 (1.04-1.13) and 1.20 (1.13-1.27), P < 0.001. With updated mean SBP of 110-129 mmHg as reference, SBP of at least 140 mmHg showed risk increases of 37% for CHD, 86% for stroke and 44% for CVD (P = 0.001 to <0.001), whereas SBP of 130-139 mmHg showed nonsignificant risk increases for these outcomes. With baseline SBP of 110-129 mmHg, CHD and CVD risks increased with further SBP reduction, hazard ratios were 1.77 and 1.73 (P = 0.002), but decreased considerably for CHD, stroke and CVD with higher baseline SBP.


CONCLUSIONS
Risks of CHD and stroke increased progressively with higher SBP, with no J-shaped curves, although risk increase was significant only for SBP of at least 140 mmHg, but not comparing 130-139 and 110-129 mmHg. Additionally, baseline SBP of 110-129 mmHg showed increased CHD and CVD risk with further SBP reduction during follow-up, whereas baseline SBP of at least 130 showed benefits.
Cederholm
Jan
J
Department of Public Health and Caring Sciences/Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
Gudbjörnsdottir
Soffia
S
Eliasson
Björn
B
Zethelius
Björn
B
Eeg-Olofsson
Katarina
K
Nilsson
Peter M
PM
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D013548:Sweden / Q000453:epidemiology; D013599:Systole / Q000502:physiology