Format

Send to

Choose Destination
Hypertension. 2017 Nov;70(5):907-914. doi: 10.1161/HYPERTENSIONAHA.117.09482. Epub 2017 Aug 28.

Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin.

Author information

1
From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.). ann.navar@duke.edu.
2
From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.).

Abstract

Systolic blood pressure (SBP) treatment targets for adults with diabetes mellitus remain unclear. SBP levels among 12 275 adults with diabetes mellitus, prior cardiovascular disease, and treated hypertension were evaluated in the TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin) randomized trial of sitagliptin versus placebo. The association between baseline SBP and recurrent cardiovascular disease was evaluated using multivariable Cox proportional hazards modeling with restricted cubic splines, adjusting for clinical characteristics. Kaplan-Meier curves by baseline SBP were created to assess time to cardiovascular disease and 2 potential hypotension-related adverse events: worsening kidney function and fractures. The association between time-updated SBP and outcomes was examined using multivariable Cox proportional hazards models. Overall, 42.2% of adults with diabetes mellitus, cardiovascular disease, and hypertension had an SBP ≥140 mm Hg. The association between SBP and cardiovascular disease risk was U shaped, with a nadir ≈130 mm Hg. When the analysis was restricted to those with baseline SBP of 110 to 150 mm Hg, the adjusted association between SBP and cardiovascular disease risk was flat (hazard ratio per 10-mm Hg increase, 0.96; 95% confidence interval, 0.91-1.02). There was no association between SBP and risk of fracture. Above 150 mm Hg, higher SBP was associated with increasing risk of worsening kidney function (hazard ratio per 10-mm Hg increase, 1.10; 95% confidence interval, 1.02-1.18). Many patients with diabetes mellitus have uncontrolled hypertension. The U-shaped association between SBP and cardiovascular disease events was largely driven by those with very high or low SBP, with no difference in cardiovascular disease risk between 110 and 150 mm Hg. Lower SBP was not associated with higher risks of fractures or worsening kidney function.

KEYWORDS:

blood pressure; cardiovascular disease; diabetes mellitus; hypertension; hypotension

PMID:
28847886
PMCID:
PMC5638706
[Available on 2018-11-01]
DOI:
10.1161/HYPERTENSIONAHA.117.09482
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center