title: Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study.
abstract: OBJECTIVE
  To compare the risk associated with systolic blood pressure that meets current recommendations (that is, below 140 mm Hg) with the risk associated with lower levels in patients who have type 2 diabetes and no previous cardiovascular disease.
  
  
  METHODS
  Population based cohort study with nationwide clinical registries, 2006-12. The mean follow-up was 5.0 years.
  
  
  METHODS
  861 Swedish primary care units and hospital outpatient clinics.
  
  
  METHODS
  187 106 patients registered in the Swedish national diabetes register who had had type 2 diabetes for at least a year, age 75 or younger, and with no previous cardiovascular or other major disease.
  
  
  METHODS
  Clinical events were obtained from the hospital discharge and death registers with respect to acute myocardial infarction, stroke, a composite of acute myocardial infarction and stroke (cardiovascular disease), coronary heart disease, heart failure, and total mortality. Hazard ratios were estimated for different levels of baseline systolic blood pressure with clinical characteristics and drug prescription data as covariates.
  
  
  RESULTS
  The group with the lowest systolic blood pressure (110-119 mm Hg) had a significantly lower risk of non-fatal acute myocardial infarction (adjusted hazard ratio 0.76, 95% confidence interval 0.64 to 0.91; P=0.003), total acute myocardial infarction (0.85, 0.72 to 0.99; P=0.04), non-fatal cardiovascular disease (0.82, 0.72 to 0.93; P=0.002), total cardiovascular disease (0.88, 0.79 to 0.99; P=0.04), and non-fatal coronary heart disease (0.88, 0.78 to 0.99; P=0.03) compared with the reference group (130-139 mm Hg). There was no indication of a J shaped relation between systolic blood pressure and the endpoints, with the exception of heart failure and total mortality.
  
  
  CONCLUSIONS
  Lower systolic blood pressure than currently recommended is associated with significantly lower risk of cardiovascular events in patients with type 2 diabetes. The association between low blood pressure and increased mortality could be due to concomitant disease rather than antihypertensive treatment.
authors: Centre of Registers Västra Götaland, Gothenburg, Sweden Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden samuel.adamssoneryd@registercentrum.se.
authors: Samuel
authors: S
authors: Adamsson Eryd
authors: Centre of Registers Västra Götaland, Gothenburg, Sweden Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Soffia
authors: S
authors: Gudbjörnsdottir
authors: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Karin
authors: K
authors: Manhem
authors: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.
authors: Annika
authors: A
authors: Rosengren
authors: Centre of Registers Västra Götaland, Gothenburg, Sweden.
authors: Ann-Marie
authors: AM
authors: Svensson
authors: Centre of Registers Västra Götaland, Gothenburg, Sweden.
authors: Mervete
authors: M
authors: Miftaraj
authors: Centre of Registers Västra Götaland, Gothenburg, Sweden.
authors: Stefan
authors: S
authors: Franzén
authors: Centre of Registers Västra Götaland, Gothenburg, Sweden.
authors: Staffan
authors: S
authors: Björck
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012042:Registries; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013599:Systole