Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk

on behalf of the SAVOR-TIMI 53 Investigators

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

Aims Optimal blood pressure for prevention of cardiovascular (CV) events in patients with Type 2 diabetes mellitus (T2DM) remains uncertain and there is concern for increased risk with low diastolic blood pressure (DBP). This study analysed the association between blood pressure and CV outcomes in high-risk patients with T2DM. Methods Patients with T2DM and elevated CV risk were enrolled in the Saxagliptin Assessment of Vascular Outcomes and results Recorded in patients with diabetes mellitus—Thrombolysis in Myocardial Infarction 53 trial. Cardiovascular outcomes were compared in the biomarker subgroup (n = 12 175) after stratification by baseline systolic blood pressure (SBP) and DBP. Adjusted risk was calculated by blood pressure stratum using clinical covariates plus N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-T (hsTnT). Trends were tested using linear and quadratic models. Adjusted risk of the composite endpoint of CV death, myocardial infarction (MI), or ischaemic stroke showed U-shaped relationships with baseline SBP and DBP (P quadratic <_ 0.01) with nadirs at SBP 130–140 or DBP 80–90 mmHg. Diastolic blood pressure <60 mmHg was associated with increased risk of MI (adjusted hazard ratio 2.30; 95% confidence interval 1.50–3.53) relative to DBP 80–90 mmHg. Adjusted odds of hsTnT concentration >_14 ng/L showed U-shaped relationships with SBP and DBP (P quadratic <_ 0.01). The relationships between low DBP, elevated hsTnT, and increased MI remained after exclusion of patients with prior heart failure or NT-proBNP >median, suggesting that the relationship was not due to confounding from diagnosed or undiagnosed heart failure. Conclusions In patients with diabetes and elevated CV risk, even after extensive adjustment for underlying disease burden, there was a persistent association for low DBP with subclinical myocardial injury and risk of MI.

Original languageEnglish (US)
Pages (from-to)2255-2262
Number of pages8
JournalEuropean Heart Journal
Volume39
Issue number24
DOIs
StatePublished - Jun 1 2018

Fingerprint

Blood Pressure
Type 2 Diabetes Mellitus
Myocardial Infarction
Hypotension
Troponin T
Brain Natriuretic Peptide
Blood Vessels
Linear Models
Heart Failure
Biomarkers
Stroke
Outcome Assessment (Health Care)

Keywords

  • Biomarkers
  • Blood pressure
  • Diabetes
  • Hypertension

PubMed: MeSH publication types

  • Journal Article

Cite this

Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk. / on behalf of the SAVOR-TIMI 53 Investigators.

In: European Heart Journal, Vol. 39, No. 24, 01.06.2018, p. 2255-2262.

Research output: Contribution to journalReview article

on behalf of the SAVOR-TIMI 53 Investigators. / Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk. In: European Heart Journal. 2018 ; Vol. 39, No. 24. pp. 2255-2262.
@article{f5b294d651d943a582ce091369b1229f,
title = "Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk",
abstract = "Aims Optimal blood pressure for prevention of cardiovascular (CV) events in patients with Type 2 diabetes mellitus (T2DM) remains uncertain and there is concern for increased risk with low diastolic blood pressure (DBP). This study analysed the association between blood pressure and CV outcomes in high-risk patients with T2DM. Methods Patients with T2DM and elevated CV risk were enrolled in the Saxagliptin Assessment of Vascular Outcomes and results Recorded in patients with diabetes mellitus—Thrombolysis in Myocardial Infarction 53 trial. Cardiovascular outcomes were compared in the biomarker subgroup (n = 12 175) after stratification by baseline systolic blood pressure (SBP) and DBP. Adjusted risk was calculated by blood pressure stratum using clinical covariates plus N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-T (hsTnT). Trends were tested using linear and quadratic models. Adjusted risk of the composite endpoint of CV death, myocardial infarction (MI), or ischaemic stroke showed U-shaped relationships with baseline SBP and DBP (P quadratic <_ 0.01) with nadirs at SBP 130–140 or DBP 80–90 mmHg. Diastolic blood pressure <60 mmHg was associated with increased risk of MI (adjusted hazard ratio 2.30; 95{\%} confidence interval 1.50–3.53) relative to DBP 80–90 mmHg. Adjusted odds of hsTnT concentration >_14 ng/L showed U-shaped relationships with SBP and DBP (P quadratic <_ 0.01). The relationships between low DBP, elevated hsTnT, and increased MI remained after exclusion of patients with prior heart failure or NT-proBNP >median, suggesting that the relationship was not due to confounding from diagnosed or undiagnosed heart failure. Conclusions In patients with diabetes and elevated CV risk, even after extensive adjustment for underlying disease burden, there was a persistent association for low DBP with subclinical myocardial injury and risk of MI.",
keywords = "Biomarkers, Blood pressure, Diabetes, Hypertension",
author = "{on behalf of the SAVOR-TIMI 53 Investigators} and Bergmark, {Brian A.} and Scirica, {Benjamin M.} and Steg, {Ph Gabriel} and Christina Fanola and Yared Gurmu and Ofri Mosenzon and Avivit Cahn and Itamar Raz and Bhatt, {Deepak L.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1093/eurheartj/ehx809",
language = "English (US)",
volume = "39",
pages = "2255--2262",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "24",

}

TY - JOUR

T1 - Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk

AU - on behalf of the SAVOR-TIMI 53 Investigators

AU - Bergmark, Brian A.

AU - Scirica, Benjamin M.

AU - Steg, Ph Gabriel

AU - Fanola, Christina

AU - Gurmu, Yared

AU - Mosenzon, Ofri

AU - Cahn, Avivit

AU - Raz, Itamar

AU - Bhatt, Deepak L.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Aims Optimal blood pressure for prevention of cardiovascular (CV) events in patients with Type 2 diabetes mellitus (T2DM) remains uncertain and there is concern for increased risk with low diastolic blood pressure (DBP). This study analysed the association between blood pressure and CV outcomes in high-risk patients with T2DM. Methods Patients with T2DM and elevated CV risk were enrolled in the Saxagliptin Assessment of Vascular Outcomes and results Recorded in patients with diabetes mellitus—Thrombolysis in Myocardial Infarction 53 trial. Cardiovascular outcomes were compared in the biomarker subgroup (n = 12 175) after stratification by baseline systolic blood pressure (SBP) and DBP. Adjusted risk was calculated by blood pressure stratum using clinical covariates plus N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-T (hsTnT). Trends were tested using linear and quadratic models. Adjusted risk of the composite endpoint of CV death, myocardial infarction (MI), or ischaemic stroke showed U-shaped relationships with baseline SBP and DBP (P quadratic <_ 0.01) with nadirs at SBP 130–140 or DBP 80–90 mmHg. Diastolic blood pressure <60 mmHg was associated with increased risk of MI (adjusted hazard ratio 2.30; 95% confidence interval 1.50–3.53) relative to DBP 80–90 mmHg. Adjusted odds of hsTnT concentration >_14 ng/L showed U-shaped relationships with SBP and DBP (P quadratic <_ 0.01). The relationships between low DBP, elevated hsTnT, and increased MI remained after exclusion of patients with prior heart failure or NT-proBNP >median, suggesting that the relationship was not due to confounding from diagnosed or undiagnosed heart failure. Conclusions In patients with diabetes and elevated CV risk, even after extensive adjustment for underlying disease burden, there was a persistent association for low DBP with subclinical myocardial injury and risk of MI.

AB - Aims Optimal blood pressure for prevention of cardiovascular (CV) events in patients with Type 2 diabetes mellitus (T2DM) remains uncertain and there is concern for increased risk with low diastolic blood pressure (DBP). This study analysed the association between blood pressure and CV outcomes in high-risk patients with T2DM. Methods Patients with T2DM and elevated CV risk were enrolled in the Saxagliptin Assessment of Vascular Outcomes and results Recorded in patients with diabetes mellitus—Thrombolysis in Myocardial Infarction 53 trial. Cardiovascular outcomes were compared in the biomarker subgroup (n = 12 175) after stratification by baseline systolic blood pressure (SBP) and DBP. Adjusted risk was calculated by blood pressure stratum using clinical covariates plus N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-T (hsTnT). Trends were tested using linear and quadratic models. Adjusted risk of the composite endpoint of CV death, myocardial infarction (MI), or ischaemic stroke showed U-shaped relationships with baseline SBP and DBP (P quadratic <_ 0.01) with nadirs at SBP 130–140 or DBP 80–90 mmHg. Diastolic blood pressure <60 mmHg was associated with increased risk of MI (adjusted hazard ratio 2.30; 95% confidence interval 1.50–3.53) relative to DBP 80–90 mmHg. Adjusted odds of hsTnT concentration >_14 ng/L showed U-shaped relationships with SBP and DBP (P quadratic <_ 0.01). The relationships between low DBP, elevated hsTnT, and increased MI remained after exclusion of patients with prior heart failure or NT-proBNP >median, suggesting that the relationship was not due to confounding from diagnosed or undiagnosed heart failure. Conclusions In patients with diabetes and elevated CV risk, even after extensive adjustment for underlying disease burden, there was a persistent association for low DBP with subclinical myocardial injury and risk of MI.

KW - Biomarkers

KW - Blood pressure

KW - Diabetes

KW - Hypertension

UR - http://www.scopus.com/inward/record.url?scp=85050911772&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050911772&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehx809

DO - 10.1093/eurheartj/ehx809

M3 - Review article

VL - 39

SP - 2255

EP - 2262

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 24

ER -