Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk

Aims Studies have shown a non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and outcomes, with increased risk observed at both low and high blood pressure (BP) levels. We hypothesized that the BP-risk association is different in individuals with and wit...

Descripción completa

Detalles Bibliográficos
Autores: Bohm, M, Schumacher, H, Teo, KK, Lonn, EM, Mahfoud, F, Mann, JFE, Mancia, G, Redon, J, Schmieder, RE, Marx, N, Sliwa, K, Weber, MA, Williams, B, Yusuf, S
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p3930
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/3930
Access Level:acceso abierto
Palabra clave:Blood pressure
Hypertension
High cardiovascular risk
Diabetes
Stroke
Myocardial infarction
id ES_80f6d684fafbc7a6fa9cbc20a2fa0f83
oai_identifier_str oai:incliva.fundanetsuite.com:p3930
network_acronym_str ES
network_name_str España
repository_id_str
spelling Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular riskBohm, MSchumacher, HTeo, KKLonn, EMMahfoud, FMann, JFEMancia, GRedon, JSchmieder, REMarx, NSliwa, KWeber, MAWilliams, BYusuf, SBlood pressureHypertensionHigh cardiovascular riskDiabetesStrokeMyocardial infarctionAims Studies have shown a non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and outcomes, with increased risk observed at both low and high blood pressure (BP) levels. We hypothesized that the BP-risk association is different in individuals with and without diabetes at high cardiovascular risk. Methods and results We identified patients with (N=11 487) or without diabetes (N=19 450), from 30 937 patients, from 133 centres in 44 countries with a median follow-up of 56months in the ONTARGET/TRANSCEND studies. Patients had a prior history of stroke, myocardial infarction (MI), peripheral artery disease, or were high-risk diabetics. Patients in ONTARGET had been randomized to ramipril 10mg daily, telmisartan 80mg daily, or the combination of both. Patients in TRANSCEND were ACE intolerant and randomized to telmisartan 80mg daily or matching placebo. We analysed the association of mean achieved in-trial SBP and DBP with the composite outcome of cardiovascular death, MI, stroke and hospitalization for congestive heart failure (CHF), the components of the composite, and all-cause death. Data were analysed by Cox regression and restricted cubic splines, adjusting for risk markers including treatment allocation and accompanying cardiovascular treatments. In patients with diabetes, event rates were higher across the whole spectrum of SBP and DBP compared with those without diabetes (P < 0.0001 for the primary composite outcome, P<0.01 for all other endpoints). Mean achieved in-trial SBP >= 160mmHg was associated with increased risk for the primary outcome [diabetes/no diabetes: adjusted hazard ratio (HR) 2.31 (1.93-2.76)/1.66 (1.36-2.02) compared with non-diabetics with SBP 120 to <140mmHg], with similar findings for all other endpoints in patients with diabetes, and for MI and stroke in patients without diabetes. In-trial SBP <120mmHg was associated with increased risk for the combined outcome in patients with diabetes [HR 1.53 (1.27-1.85)], and for cardiovascular death and all cause death in all patients. In-trial DBP >= 90mmHg was associated with increased risk for the primary outcome [diabetes/no diabetes: HR 2.32 (1.91-2.82)/1.61 (1.35-1.93) compared with non-diabetics with DBP 70 to <80mmHg], with similar findings for all other endpoints, but not for CHF hospitalizations in patients without diabetes. In-trial DBP <70mmHg was associated with increased risk for the combined outcome in all patients [diabetes/no diabetes: HR 1.77 (1.51-2.06)/1.30 (1.16-1.46)], and also for all other endpoints except stroke. Conclusion High on treatment BP levels (>= 160 or >= 90 mmHg) are associated with increased risk of cardiovascular outcomes and death. Also low levels (<120 or <70 mmHg) are associated with increased cardiovascular outcomes (except stroke) and death. Patients with diabetes have consistently higher risks over the whole BP range, indicating that achieving optimal BP goals is most impactful in this group. These data favour guidelines taking lower BP boundaries into consideration, in particular in diabetes.OXFORD UNIV PRESS2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/3930EUROPEAN HEART JOURNALISSN: 0195668XISSNe: 15229645reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p39302026-06-07T16:35:31Z
dc.title.none.fl_str_mv Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk
title Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk
spellingShingle Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk
Bohm, M
Blood pressure
Hypertension
High cardiovascular risk
Diabetes
Stroke
Myocardial infarction
title_short Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk
title_full Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk
title_fullStr Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk
title_full_unstemmed Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk
title_sort Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk
dc.creator.none.fl_str_mv Bohm, M
Schumacher, H
Teo, KK
Lonn, EM
Mahfoud, F
Mann, JFE
Mancia, G
Redon, J
Schmieder, RE
Marx, N
Sliwa, K
Weber, MA
Williams, B
Yusuf, S
author Bohm, M
author_facet Bohm, M
Schumacher, H
Teo, KK
Lonn, EM
Mahfoud, F
Mann, JFE
Mancia, G
Redon, J
Schmieder, RE
Marx, N
Sliwa, K
Weber, MA
Williams, B
Yusuf, S
author_role author
author2 Schumacher, H
Teo, KK
Lonn, EM
Mahfoud, F
Mann, JFE
Mancia, G
Redon, J
Schmieder, RE
Marx, N
Sliwa, K
Weber, MA
Williams, B
Yusuf, S
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Blood pressure
Hypertension
High cardiovascular risk
Diabetes
Stroke
Myocardial infarction
topic Blood pressure
Hypertension
High cardiovascular risk
Diabetes
Stroke
Myocardial infarction
description Aims Studies have shown a non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and outcomes, with increased risk observed at both low and high blood pressure (BP) levels. We hypothesized that the BP-risk association is different in individuals with and without diabetes at high cardiovascular risk. Methods and results We identified patients with (N=11 487) or without diabetes (N=19 450), from 30 937 patients, from 133 centres in 44 countries with a median follow-up of 56months in the ONTARGET/TRANSCEND studies. Patients had a prior history of stroke, myocardial infarction (MI), peripheral artery disease, or were high-risk diabetics. Patients in ONTARGET had been randomized to ramipril 10mg daily, telmisartan 80mg daily, or the combination of both. Patients in TRANSCEND were ACE intolerant and randomized to telmisartan 80mg daily or matching placebo. We analysed the association of mean achieved in-trial SBP and DBP with the composite outcome of cardiovascular death, MI, stroke and hospitalization for congestive heart failure (CHF), the components of the composite, and all-cause death. Data were analysed by Cox regression and restricted cubic splines, adjusting for risk markers including treatment allocation and accompanying cardiovascular treatments. In patients with diabetes, event rates were higher across the whole spectrum of SBP and DBP compared with those without diabetes (P < 0.0001 for the primary composite outcome, P<0.01 for all other endpoints). Mean achieved in-trial SBP >= 160mmHg was associated with increased risk for the primary outcome [diabetes/no diabetes: adjusted hazard ratio (HR) 2.31 (1.93-2.76)/1.66 (1.36-2.02) compared with non-diabetics with SBP 120 to <140mmHg], with similar findings for all other endpoints in patients with diabetes, and for MI and stroke in patients without diabetes. In-trial SBP <120mmHg was associated with increased risk for the combined outcome in patients with diabetes [HR 1.53 (1.27-1.85)], and for cardiovascular death and all cause death in all patients. In-trial DBP >= 90mmHg was associated with increased risk for the primary outcome [diabetes/no diabetes: HR 2.32 (1.91-2.82)/1.61 (1.35-1.93) compared with non-diabetics with DBP 70 to <80mmHg], with similar findings for all other endpoints, but not for CHF hospitalizations in patients without diabetes. In-trial DBP <70mmHg was associated with increased risk for the combined outcome in all patients [diabetes/no diabetes: HR 1.77 (1.51-2.06)/1.30 (1.16-1.46)], and also for all other endpoints except stroke. Conclusion High on treatment BP levels (>= 160 or >= 90 mmHg) are associated with increased risk of cardiovascular outcomes and death. Also low levels (<120 or <70 mmHg) are associated with increased cardiovascular outcomes (except stroke) and death. Patients with diabetes have consistently higher risks over the whole BP range, indicating that achieving optimal BP goals is most impactful in this group. These data favour guidelines taking lower BP boundaries into consideration, in particular in diabetes.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/3930
url https://incliva.portalinvestigacion.com/publicaciones/3930
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv OXFORD UNIV PRESS
publisher.none.fl_str_mv OXFORD UNIV PRESS
dc.source.none.fl_str_mv EUROPEAN HEART JOURNAL
ISSN: 0195668X
ISSNe: 15229645
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869411939074965504
score 15,811543

Similares en LA Referencia