Effect of BP reduction on HF risk attenuated by improper glycemic control

Effect of BP reduction on the risk of developing Heart Failure was attenuated with deteriorating glucose tolerance according to a recent study published in the American Heart Journal, 2022. 

The toll of Diabetes as a global pandemic continues to grow worldwide. Diabetes when associated with hypertension shows an exaggerated effect and may cause a burden on the heart leading to incident cardiovascular diseases. So, researchers conducted a study to evaluate the clinical benefit of blood pressure (BP) reduction in individuals with diabetes and identify the clinical impact of BP reduction on incident cardiovascular disease in people having diabetes and hypertension. 

A retrospective cohort study was conducted on 754,677 individuals with stage 1 and stage 2 hypertension. The mean age of the patients was 47 years with 75,8% being males. Categorization of patients was done using fasting plasma glucose (FPG) at baseline as normal FPG (FPG < 100 mg/dL) having 5,17,372 participants, prediabetes (FPG:100-125 mg/dL) having 1,97,836 participants, or diabetes mellitus (FPG ≥126 mg/dL) having 39,469 participants. The primary measurement outcome was heart failure (HF), and the secondary outcomes included ischemic heart disease (IHD) including myocardial infarction, angina pectoris, and stroke. 

Results: 

• Over a mean follow-up of 1111±909 days, 18,429 HFs, 17,058 IHDs, and 8,795 strokes were recorded.
• Reduction in BP of< 120/80 mmHg at one year was associated with a lower risk of developing HF, IHD, and stroke in individuals with normal FPG. 
• But it was not associated with a risk of developing HF and stroke in those with DM.
• Interaction analyses showed that the influence of BP reduction on incident HF was attenuated in people with prediabetes or DM.
• All the results were confirmed by the multitude of sensitivity analyses. 

Thus, the researchers concluded that the risk of developing HF was attenuated with deteriorating glucose tolerance and associated BP reduction. They also added that the management strategy for hypertensive people with prediabetes or DM has to be established for the prevention of developing cardiovascular disease (particularly HF). 

To read the full article, click here: https://doi.org/10.1016/j.ahj.2022.07.005 

Suzuki Y, Kaneko H, Yano Y, et al. Glycemic status and the association of change in blood pressure with incident cardiovascular disease. American Heart Journal. Published online July 2022.