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Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish national diabetes register.

Cederholm, Jan; Gudbjörnsdottir, Soffia; Eliasson, Björn; Zethelius, Björn; Berg, Katarina LU and Nilsson, Peter LU (2010) In Journal of Hypertension 28. p.2026-2035
Abstract
OBJECTIVES: To estimate risks of fatal/nonfatal coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with SBP in an observational study of patients with type 2 diabetes. METHODS: Twelve thousand, six hundred and seventy-seven patients aged 30-75 years, treated with antihypertensive drugs, without previous congestive heart failure, followed for 5 years. RESULTS: Risk curves of CHD and stroke increased progressively with higher baseline or updated mean SBP in a Cox model, in all participants, and in two subgroups without (n = 10 304) or with (n = 2373) a history of CVD, with no J-shaped risk curves at low SBP levels. Hazard ratios for CHD and stroke per 10-mmHg increase in updated mean SBP in all participants, adjusting for... (More)
OBJECTIVES: To estimate risks of fatal/nonfatal coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with SBP in an observational study of patients with type 2 diabetes. METHODS: Twelve thousand, six hundred and seventy-seven patients aged 30-75 years, treated with antihypertensive drugs, without previous congestive heart failure, followed for 5 years. RESULTS: Risk curves of CHD and stroke increased progressively with higher baseline or updated mean SBP in a Cox model, in all participants, and in two subgroups without (n = 10 304) or with (n = 2373) a history of CVD, with no J-shaped risk curves at low SBP levels. Hazard ratios for CHD and stroke per 10-mmHg increase in updated mean SBP in all participants, adjusting for clinical characteristics and traditional risk factors, were 1.08 (1.04-1.13) and 1.20 (1.13-1.27), P < 0.001. With updated mean SBP of 110-129 mmHg as reference, SBP of at least 140 mmHg showed risk increases of 37% for CHD, 86% for stroke and 44% for CVD (P = 0.001 to <0.001), whereas SBP of 130-139 mmHg showed nonsignificant risk increases for these outcomes. With baseline SBP of 110-129 mmHg, CHD and CVD risks increased with further SBP reduction, hazard ratios were 1.77 and 1.73 (P = 0.002), but decreased considerably for CHD, stroke and CVD with higher baseline SBP. CONCLUSION: Risks of CHD and stroke increased progressively with higher SBP, with no J-shaped curves, although risk increase was significant only for SBP of at least 140 mmHg, but not comparing 130-139 and 110-129 mmHg. Additionally, baseline SBP of 110-129 mmHg showed increased CHD and CVD risk with further SBP reduction during follow-up, whereas baseline SBP of at least 130 showed benefits. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Hypertension
volume
28
pages
2026 - 2035
publisher
Lippincott Williams & Wilkins
external identifiers
  • WOS:000281867400010
  • PMID:20634718
  • Scopus:77957259177
ISSN
1473-5598
DOI
10.1097/HJH.0b013e32833c8b75
language
English
LU publication?
yes
id
6c735cf5-4bd7-4b6c-987d-50f2548003fd (old id 1644906)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20634718?dopt=Abstract
date added to LUP
2010-08-03 09:39:09
date last changed
2016-10-23 04:30:03
@misc{6c735cf5-4bd7-4b6c-987d-50f2548003fd,
  abstract     = {OBJECTIVES: To estimate risks of fatal/nonfatal coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with SBP in an observational study of patients with type 2 diabetes. METHODS: Twelve thousand, six hundred and seventy-seven patients aged 30-75 years, treated with antihypertensive drugs, without previous congestive heart failure, followed for 5 years. RESULTS: Risk curves of CHD and stroke increased progressively with higher baseline or updated mean SBP in a Cox model, in all participants, and in two subgroups without (n = 10 304) or with (n = 2373) a history of CVD, with no J-shaped risk curves at low SBP levels. Hazard ratios for CHD and stroke per 10-mmHg increase in updated mean SBP in all participants, adjusting for clinical characteristics and traditional risk factors, were 1.08 (1.04-1.13) and 1.20 (1.13-1.27), P &lt; 0.001. With updated mean SBP of 110-129 mmHg as reference, SBP of at least 140 mmHg showed risk increases of 37% for CHD, 86% for stroke and 44% for CVD (P = 0.001 to &lt;0.001), whereas SBP of 130-139 mmHg showed nonsignificant risk increases for these outcomes. With baseline SBP of 110-129 mmHg, CHD and CVD risks increased with further SBP reduction, hazard ratios were 1.77 and 1.73 (P = 0.002), but decreased considerably for CHD, stroke and CVD with higher baseline SBP. CONCLUSION: Risks of CHD and stroke increased progressively with higher SBP, with no J-shaped curves, although risk increase was significant only for SBP of at least 140 mmHg, but not comparing 130-139 and 110-129 mmHg. Additionally, baseline SBP of 110-129 mmHg showed increased CHD and CVD risk with further SBP reduction during follow-up, whereas baseline SBP of at least 130 showed benefits.},
  author       = {Cederholm, Jan and Gudbjörnsdottir, Soffia and Eliasson, Björn and Zethelius, Björn and Berg, Katarina and Nilsson, Peter},
  issn         = {1473-5598},
  language     = {eng},
  pages        = {2026--2035},
  publisher    = {ARRAY(0xb798198)},
  series       = {Journal of Hypertension},
  title        = {Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish national diabetes register.},
  url          = {http://dx.doi.org/10.1097/HJH.0b013e32833c8b75},
  volume       = {28},
  year         = {2010},
}