Uncontrolled Hypertension in Diabetics Leads to Other Cardiovascular Events

Patients with diabetes who delay treating hypertension are more likely to experience heart attack or stroke, according to a study published in Diabetes Care.

Researchers evaluated 43,986 patients with diabetes who newly initiated antihypertensive treatment between 2002 and 2007. Patients were categorized based on systolic blood pressure (SBP) at treatment initiation: 130 to 139 mmHg and ≥140 mmHg. They were then categorized by SBP after two years of treatment: 100 to 119 mmHg, 120 to 129 mmHg, 130 to 139 mmHg, 140 to 159 mmHg, and ≥160 mmHg. The primary outcome was composite atherosclerotic cardiovascular disease (ASCVD) events, defined as fatal and non-fatal myocardial infarction (MI) and stroke.

Patients who waited to start antihypertensive treatment until SBP was higher were 10% more likely to experience MI and stroke.

Compared with those who initiated treatment at an SBP of 130 to 139 mmHg, those with pretreatment SBP ≥140 mmHg had higher ASCVD risk (hazard ratio = 1.10; 95% confidence interval [CI], 1.02-1.19), suggesting that patients who begin antihypertensive therapy when SBP exceeds 130 mmHg may reduce the risk of death from heart attacks and strokes compared with diabetics who wait to initiate treatment until blood pressure is higher.

Compared with those with pretreatment SBP of 130 to 139 mmHg and on-treatment SBP of 120 to 129 mmHg (reference group), ASCVD incidence was higher in those with pretreatment SBP ≥140 mmHg and on-treatment SBP 120 to 129 mmHg (adjusted incidence rate difference [IRD] = 1.0; 95% CI, −0.2-2.1). It is also higher in those who achieved on-treatment SBP 130 to 139 mmHg (IRD=1.9; 95% CI, 0.6-3.2 for pretreatment SBP 130 to 139 mmHg and IRD=1.1; 95% CI, 0.04-2.2 for pretreatment SBP ≥140 mmHg). This suggests that among diabetics with pretreatment SBP exceeding 140 mmHg, achieving SBP <130 mmHg during treatment still resulted in a worse cardiovascular risk compared with those who started treatment when pretreatment SBP was below 140 mmHg.

“Patients with diabetes initiating antihypertensive therapy when SBP was 130 to 139 mmHg and those achieving on-treatment SBP <130 mmHg had better outcomes than those with higher SBP levels when initiating or after two years on treatment,” the researchers concluded. Read more