Association of Blood Pressure With Cardio-Renal Events and Mortality in Type 2 DM: A National Health Insurance Database

• Published in: The journal of clinical endocrinology and metabolism Vol. 109; no. 1; pp. 227 - 236
• Main Authors: Kim, Bo-Yeon, Lee, Ji-In, Lee, Hye-Mi, Kim, So Hun, Mo, Eun Yeong, Son, Jang Won, Lee, Sihoon, Kim, Sungrae
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.01.2024
• Subjects: Angiotensin; Blood pressure; Blood Pressure - physiology; Cardiovascular agents; Clinical; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Enzyme inhibitors; Glycosylated hemoglobin; Humans; Hypertension; Hypertension - complications; Hypertension - epidemiology; Kidney Diseases; Mortality; National health insurance; National Health Programs; Population studies; Type 2 diabetes; South Korea; type 2 diabetes mellitus; cardiovascular disease; blood pressure; hypertension; Korea
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/clinem/dgad404

Abstract Context The relationship of blood pressure (BP) with cardio-renal events and all-cause mortality in type 2 diabetes mellitus (T2DM) is still controversial. Objective To investigate the optimal BP target in Korean individuals with T2DM. Methods Using the Korean National Health Insurance System database, data of individuals with T2DM who underwent regular health checks from January 1, 2007, to December 31, 2007, were extracted (N = 1 800 073). Among them, a total of 326 593 individuals were included in the final study. The study population was divided into 7 groups according to their observed systolic blood pressure (SBP) (<110, 110-119, 120-129, 130-139, 140-149, 150-159, 160-169, and ≥170 mmHg) and diastolic blood pressure (DBP) (<65, 65-69, 70-74, 75-79, 80-84, 85-89, and ≥90 mmHg). Hazard ratios (HRs) of cardio-renal events and all-cause mortality according to BP categories were analyzed. Results Compared with SBP of 120-129 mmHg and DBP of 75-79 mmHg, SBP of ≥130 mmHg and DBP of ≥ 80 mmHg were associated with an increase in HR of major cardiovascular adverse events (MACEs). SBP of 120-129 mmHg and DBP 75-79 mmHg were associated with the lowest HR of all-cause mortality. Both lower BP (SBP/DBP <120/70 mm) and higher BP (SBP/DBP ≥130/80 mmHg) were associated with an increased HR of all-cause mortality. Contrary to MACE, the lower the SBP, the lower the HR of renal events. Conclusion In patients with T2DM, the optimal cutoff value of BP associated with a lower incidence of MACE and mortality may be 120-129 mmHg for SBP and 75-79 mmHg for DBP. However, lower SBP may be helpful for T2DM patients with a high risk of renal disease.