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.
RESEARCH DESIGN AND METHODS We performed a prospective cohort study (2000–2009) on diabetic patients including 17,536 African American and 12,618 white. 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 (allP trend <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.
- Received January 22, 2013.
- Accepted March 2, 2013.
- © 2013 by the American Diabetes Association.
Graham
1 comment:
As always interesting to read the studies and reports that are available. Sometimes it may help to be a medical student, which I am not. I do question treating a complaint too aggressively. Is it not better to lower blood pressure, lower HbA1c, lower any complaint slowly and keep it that way slowly, steadily so allowing the body to become adjusted, as too quick,too prolonged may cause more harm. As I said I am not medically equipped this is only my view on the matter.
Sincerely Joshi
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