title: Aggressive blood pressure control increases coronary heart disease risk among diabetic patients.
abstract: OBJECTIVE
  Blood pressure control can reduce the risk of coronary heart disease (CHD) among diabetic patients; however, it is not known whether the lowest risk of CHD is among diabetic patients with the lowest blood pressure level.
  
  
  METHODS
  We performed a prospective cohort study (2000-2009) on diabetic patients including 17,536 African Americans and 12,618 whites. Cox proportional hazards regression models were used to estimate the association of blood pressure with CHD risk.
  
  
  RESULTS
  During a mean follow-up of 6.0 years, 7,260 CHD incident cases were identified. The multivariable-adjusted hazard ratios of CHD associated with different levels of systolic/diastolic blood pressure at baseline (<110/65, 110-119/65-69, 120-129/70-80, and 130-139/80-90 mmHg [reference group]; 140-159/90-100; and ≥160/100 mmHg) were 1.73, 1.16, 1.04, 1.00, 1.06, and 1.11 (P trend<0.001), respectively, for African American diabetic patients, and 1.60, 1.27, 1.08, 1.00, 0.95, and 0.99 (P trend<0.001) for white diabetic patients, respectively. A U-shaped association of isolated systolic and diastolic blood pressure at baseline as well as blood pressure during follow-up with CHD risk was observed among both African American and white diabetic patients (all Ptrend<0.001). The U-shaped association was present in the younger age-group (30-49 years), and this U-shaped association changed to an inverse association in the older age-group (≥60 years).
  
  
  CONCLUSIONS
  Our study suggests that there is a U-shaped or inverse association between blood pressure and the risk of CHD, and aggressive blood pressure control (blood pressure<120/70 mmHg) is associated with an increased risk of CHD among both African American and white patients with diabetes.
authors.affiliation: Corresponding author: Gang Hu, gang.hu@pbrc.edu.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Zhao
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.forename: Ronald
authors.initials: R
authors.lastname: Horswell
authors.forename: Yujie
authors.initials: Y
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Jolene
authors.initials: J
authors.lastname: Johnson
authors.forename: Steven B
authors.initials: SB
authors.lastname: Heymsfield
authors.forename: William T
authors.initials: WT
authors.lastname: Cefalu
authors.forename: Donna H
authors.initials: DH
authors.lastname: Ryan
authors.forename: Gang
authors.initials: G
authors.lastname: Hu
mesh_terms: D000328:Adult; D001741:Black or African American; D001794:Blood Pressure / Q000502:physiology*; D003327:Coronary Disease / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D044465:White People