title: Association of systolic and diastolic blood pressure and all cause mortality in people with newly diagnosed type 2 diabetes: retrospective cohort study.
abstract: OBJECTIVE
  To examine the effect of systolic and diastolic blood pressure achieved in the first year of treatment on all cause mortality in patients newly diagnosed with type 2 diabetes, with and without established cardiovascular disease.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  United Kingdom General Practice Research Database, between 1990 and 2005.
  
  
  METHODS
  126,092 adult patients (age ≥ 18 years) with a new diagnosis of type 2 diabetes who had been registered with participating practices for at least 12 months.
  
  
  METHODS
  All cause mortality.
  
  
  RESULTS
  Before diagnosis, 12,379 (9.8%) patients had established cardiovascular disease (myocardial infarction or stroke). During a median follow-up of 3.5 years, we recorded 25,495 (20.2%) deaths. In people with cardiovascular disease, tight control of systolic (<130 mm Hg) and diastolic (<80 mm Hg) blood pressure was not associated with improved survival, after adjustment for baseline characteristics (age at diagnosis, sex, practice level clustering, deprivation score, body mass index, smoking, HbA(1c) and cholesterol levels, and blood pressure). Low blood pressure was also associated with an increased risk of all cause mortality. Compared with patients who received usual control of systolic blood pressure (130-139 mm Hg), the hazard ratio of all cause mortality was 2.79 (95% confidence interval 1.74 to 4.48, P<0.001) for systolic blood pressure at 110 mm Hg. Compared with patients who received usual control of diastolic blood pressure (80-84 mm Hg), the hazard ratios were 1.32 (1.02 to 1.78, P=0.04) and 1.89 (1.40 to 2.56, P<0.001) for diastolic blood pressures at 70-74 mm Hg and lower than 70 mm Hg, respectively. Similar associations were found in people without cardiovascular disease. Subgroup analyses of people diagnosed with hypertension and who received treatment for hypertension confirmed initial findings.
  
  
  CONCLUSIONS
  Blood pressure below 130/80 mm Hg was not associated with reduced risk of all cause mortality in patients with newly diagnosed diabetes, with or without known cardiovascular disease. Low blood pressure, particularly below 110/75 mm Hg, was associated with an increased risk for poor outcomes.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: Eszter Panna
authors.initials: EP
authors.lastname: Vamos
authors.forename: Matthew
authors.initials: M
authors.lastname: Harris
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.forename: Utz J
authors.initials: UJ
authors.lastname: Pape
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.forename: Vasa
authors.initials: V
authors.lastname: Curcin
authors.forename: Mariam
authors.initials: M
authors.lastname: Molokhia
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D007022:Hypotension / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D006113:United Kingdom
chemical_list: D000959:Antihypertensive Agents