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

An increase in BP above optimal levels is the most usual chronic risk factor for cardiovascular disease worldwide, and CVD remains the forefront cause of disability and death. There seemed a continuous, log-linear relationship between levels of BP and CVD and mortality risk that extends to as low as 90 mm Hg. Previous studies have focused on single BP measurements from a particular cycle or age. These standard BP measures do not consider the magnitude and duration of elevated BP exposure over time. However, in recent years, there has been an increasing interest in actions that indicate aspects of BP exposure over time than at one point.

Against the above background, Nelson Wang, Royal Prince Alfred Hospital, Sydney, Australia, and colleagues aimed to investigate the association between cumulative SBP load and risk of cardiovascular events risk in type 2 diabetes patients.

For this purpose, the researchers conducted a post hoc analysis of type 2 diabetes patients followed by the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation - Observational Study (ADVANCE-ON).

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.