Lower blood pressure associated with higher mortality in elderly diabetic patients (ZODIAC-12).
OBJECTIVE
to investigate the relationship between blood pressure over time and mortality in elderly patients with type 2 diabetes mellitus (T2DM).


METHODS
prospective observational cohort study.


METHODS
primary care, Zwolle, The Netherlands.


METHODS
patients with T2DM aged 60 years and older (n = 881). The cohort was divided into two age categories: 60-75 years and older than 75 years.


METHODS
updated means for systolic, diastolic and pulse pressures were calculated after a median follow-up time of 9.8 years. These values were used as time-dependent covariates in a Cox proportional hazard model. Main outcome measures were all-cause and cardiovascular mortality.


RESULTS
all of the blood pressure measures were inversely related to all-cause mortality in elderly diabetic patients (>75 years). Furthermore, these relationships were specifically found in elderly patients treated with antihypertensive medication at baseline. A decrease of 10 mm Hg in systolic blood pressure, diastolic blood pressure and pulse pressure led to a mortality increase of 22% [95% confidence interval (95% CI): 13-31%], 30% [95% CI: 13%-46%] and 22% [95% CI: 11%-33%], respectively. In the low age group (60-75 years), no relationship was found between blood pressure and mortality.


CONCLUSIONS
blood pressure is a marker for mortality in elderly T2DM patients; however, the relationship is inverse.
van Hateren
Kornelis J J
KJ
Diabetes Centre, Isala Clinics, Zwolle, The Netherlands. k.j.j.van.hateren@isala.nl
Landman
Gijs W D
GW
Kleefstra
Nanne
N
Groenier
Klaas H
KH
Kamper
Adriaan M
AM
Houweling
Sebastiaan T
ST
Bilo
Henk J G
HJ
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
D000959:Antihypertensive Agents