(03-10-12) Association of systolic and diastolic blood pressure and all cause mortality in people with newly diagnosed type 2 diabetes:

retrospective cohort study.
Vamos EP, Harris M, Millett C, Pape UJ, Khunti K, Curcin V, Molokhia M, Majeed
A.
Source
Department of Primary Care and Public Health, Imperial College London, London
W6 8RP, UK.
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.
DESIGN:
Retrospective cohort study.
SETTING:
United Kingdom General Practice Research Database, between 1990 and 2005.
PARTICIPANTS:
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.
MAIN OUTCOME MEASURE:
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.
CONCLUSION:
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.


BMJ. 2012 Aug 30;345:e5567. doi: 10.1136/bmj.e5567.

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