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 Americans and 12,618 whites. 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 (all Ptrend<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.
journal_name
Diabetes Carejournal_title
Diabetes careauthors
Zhao W,Katzmarzyk PT,Horswell R,Wang Y,Li W,Johnson J,Heymsfield SB,Cefalu WT,Ryan DH,Hu Gdoi
10.2337/dc13-0189subject
Has Abstractpub_date
2013-10-01 00:00:00pages
3287-96issue
10eissn
0149-5992issn
1935-5548pii
dc13-0189journal_volume
36pub_type
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