Cumulative high BP is better for predicting cardiovascular and death risk in type 2 diabetes patients: JACC

The area under the curve for SBP values ≥130 mm Hg divided by the under the curve for all measured SBP values throughout 24-month exposure comprised cumulative SBP load. Cox models were used to determine the association between cumulative SBP load with significant cardiovascular risk and mortality.

The study led to the following findings:

• The researchers observed 1,469 major cardiovascular events, 1,615 deaths, and 660 cardiovascular deaths over a median of 7.6 years of follow-up in 9,338 participants.
• Each 1-SD increase in cumulative SBP load was associated with a 14% increase in major cardiovascular events (HR: 1.14), a 13% increase in all-cause mortality (HR: 1.13), and a 21% increase in cardiovascular death (HR: 1.21).
• For predicting cardiovascular events and death, cumulative SBP load outperformed mean SBP, time-below-target SBP, and visit-to-visit SBP variability in Akaike information criterion and net reclassification indexes.

"In patients with type 2 diabetes, cumulative SBP load provides a better indication of future major cardiovascular events risk than traditional BP measures," wrote the authors. "These results reinforce the significance of both duration and magnitude of exposure to elevated SBP for assessing cardiovascular risk."

Reference:

Wang N, Harris K, Hamet P, et al. Cumulative systolic blood pressure load and cardiovascular risk in patients with diabetes. J Am Coll Cardiol. 2022;80(12):1147-1155.