Association between blood pressure and risk of cardiovascular hospital admissions among people with type 2 diabetes.
OBJECTIVE
To investigate the association between systolic and diastolic blood pressure (BP) and risk of hospitalisation among patients with type 2 diabetes.


METHODS
4704 patients with type 2 diabetes from 18 general practices in Cambridgeshire were included. BP was assessed in 2008-2009. The primary outcome was cardiovascular hospital admissions in 2009-2011. Adjusted relative risks for each BP measurement group were estimated using Cox models. Further dose-response relationships between BP and risks were explored using restricted cubic spline models.


RESULTS
Over a median follow-up of 2 years, we recorded 5322 hospital admissions. There was a non-linear relationship between systolic (SBP) and diastolic (DBP) BP and the risk of cardiovascular hospitalisation (both p<0.001 for linearity test). The BP associated with the lowest risk of cardiovascular hospitalisation was 137 (95% CI 133 to 141)/78 (95% CI 76 to 80) mm Hg. The discrimination of the model could be significantly improved with either an SBP threshold or a DBP threshold (both p<0.0001).


CONCLUSIONS
Among patients with type 2 diabetes, the risk of cardiovascular hospitalisation is lowest with a BP of 133-141/76-80 mm Hg. This concurs with the latest recommended randomised controlled trial based BP target of 140/80 from the American Diabetes Association.
Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Dahai
D
Yu
Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
David
D
Simmons
D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D010343:Patient Admission; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors