Blood pressure trajectories before death in patients with type 2 diabetes

Abstract

The aim of this study is to examine the trajectory of blood pressure (BP) over two yrs before death or censoring and its association with mortality in patients (pts) with T2DM. A cohort of 19966 pts with minimum 3 yrs of diabetes duration (DD) was selected from the UK General Practice Research Database (1990-2008), who had four consecutive 6-monthly BP measures over 2 yrs immediately before death or censoring. In the cohort, 46% were female, mean (SD) age of 68 (11) years and 14% had at least one cardiovascular event (CVE) before diagnosis of diabetes. During 6.5 years of median duration of follow-up, 7% pts died, of whom 83% were aged ≥ 68 yrs, 53% and 20% pts had CVE respectively in dead and alive groups. During 2 yrs of follow-up, pts’ systolic and diastolic BP trajectories were significantly higher by 5 and 2 mmHg respectively in those who died, compared to those who were alive (Fig 1). These estimates were adjusted for the effects of age, DD, sex, CVE, glucose-lowering and anti-hypertensive medication usages, baseline weight and HbA1c. Compared to pts with systolic BP level 125 - 130 mmHg, pts with BP 140 mmHg had significantly higher mortality risk by 240% (adjusted odds ratio : 2.4, 95% CI: 1.9, 3.1) and 210% (adjusted odds ratio: 2.1, 95% CI: 1.8, 2.5) respectively. Mortality risk was not higher in patients with BP within 130 - 140 mmHg (Fig 1). The population level analyses of BP trajectories leading up to death are revealing, and provide clear message in terms of the requirement for intensive BP control and related management policies at primary care level. Our findings also establish the J-shaped relationship between systolic BP and mortality