Average Clinician‐Measured Blood Pressures and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus and Ischemic Heart Disease in the EXAMINE Trial

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Christopher P. Cannon¹  Yuyin Liu¹  Cyrus Mehta²  William C. Cushman³  Richard Bergenstal⁴  George L. Bakris⁵  Fatima Jalil⁶  William B. White⁶  Simon R. Heller⁷  Faiez Zannad⁸ 

[1] Baim Clinical Research Institute Boston MA;Harvard School of Public Health Boston MA;Memphis Veterans Affairs Medical Center University of Tennessee Health Science Center Memphis TN;Park Nicolett Clinic St. Louis Park MN;University of Chicago Medicine Chicago IL;University of Connecticut School of Medicine Farmington CT;University of Sheffield United Kingdom;Université de Lorraine Nancy France;

关键词: blood pressure;    cardiovascular outcomes;    diabetes mellitus;   

DOI  :  10.1161/JAHA.118.009114

来源: DOAJ

【 摘 要 】

Background Blood pressure (BP) treatment goals in patients with diabetes mellitus and increased cardiovascular risk remain controversial. Our study objective was to determine cardiovascular outcomes according to achieved BPs over the average follow‐up period in the EXAMINE (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care) trial. Methods and Results EXAMINE was a cardiovascular outcomes trial in 5380 patients with type 2 diabetes mellitus and recent acute coronary syndromes. Risks of major adverse cardiac events and cardiovascular death or heart failure were analyzed using a Cox proportional hazards model with adjustment for baseline covariates in 10‐mm Hg increments of clinician‐measured systolic BP from ≤100 to >160 mm Hg and diastolic BP from ≤60 to >100 mm Hg averaged during the 24 months after randomization. Based on 2015 guidelines from the American College of Cardiology, the American Heart Association and the American Society of Hypertension and 2017 American Diabetes Association guidelines, systolic BPs of 131 to 140 mm Hg and diastolic BPs of 81 to 90 mm Hg were the reference groups. A U‐shaped relationship between cardiovascular outcomes and BPs was observed. Importantly, compared with the systolic BP reference group, adjusted hazard ratios for major adverse cardiac events and cardiovascular death or heart failure were significantly higher in patients with systolic BPs <130 mm Hg. Similarly, compared with the diastolic BP reference group, adjusted hazard ratios for major adverse cardiac events and for cardiovascular death or heart failure were significantly higher for diastolic BPs <80 mm Hg. Conclusions In patients with type 2 diabetes mellitus and recent acute coronary syndrome, average BPs <130/80 mm Hg were associated with worsened cardiovascular outcomes. These data suggest that intensive control of BP in patients with type 2 diabetes mellitus and ischemic heart disease should be evaluated in a prospective randomized trial. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00968708.

【 授权许可】

Unknown