A CME Journal For Family Physicians


Low Diastolic BP Raises CV Risk in Type 2 Diabetes Patients

Low diastolic blood pressure (DBP) is associated with subclinical myocardial injury and myocardial infarction (MI) risk in patients with diabetes and elevated cardiovascular (CV) risk, a new study showed.
In the Saxagliptin Assessment of Vascular Outcomes Recorded in patients with diabetes mellitus-Thrombolysis in Myocardial Infarction 53 trial, the researchers evaluated 12,175 patients with type 2 diabetes and elevated CV risk.
Patients were categorized based on baseline systolic blood pressure (SBP) and DBP, and CV outcomes were compared. Adjusted risk was calculated, and linear and quadratic models were used to test trends.
The researchers found that the adjusted risk of combined CV death, MI, or ischemic stroke demonstrated U-shaped relationships with baseline SBP and DBP (nadirs: SBP 130 to 140 mmHg; DBP 80 to 90 mmHg). Results indicated that DBP levels of less than 60 mmHg were associated with a higher risk of MI (adjusted hazard ratio [HR] 2.30) compared with DBP levels of 80 to 90 mmHg.
The researchers noted that the associations between low DBP, elevated high sensitivity troponin T levels, and increased MI remained significant following adjustment for various factors including prior heart failure.
“In patients with diabetes and elevated CV risk, even after extensive adjustment for underlying disease burden, there was a persistent association for low DBP with subclinical myocardial injury and risk of MI,” the researchers concluded.

Bergmark BA, Scirica BM, Steg PG, et al. Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk [Published online January 31, 2018]. Eur Heart J.https://doi.org/10.1093/eurheartj/ehx809.