TY - JOUR
T1 - Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial
AU - Wijkman, Magnus O.
AU - Claggett, Brian
AU - Diaz, Rafael
AU - Gerstein, Hertzel C.
AU - Køber, Lars
AU - Lewis, Eldrin
AU - Maggioni, Aldo P.
AU - Wolsk, Emil
AU - Aguilar, David
AU - Bentley-Lewis, Rhonda
AU - McMurray, John J.
AU - Probstfield, Jeffrey
AU - Riddle, Matthew
AU - Tardif, Jean Claude
AU - Solomon, Scott D.
AU - Pfeffer, Marc A.
N1 - Publisher Copyright:
© 2020 The Author(s).
PY - 2020/10/12
Y1 - 2020/10/12
N2 - Background: The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure. Methods: We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization. Results: Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99-1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04-1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86-1.04) P = 0.26; P for interaction 0.005). Conclusions: The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration. Trial registration ClinicalTrials.gov
AB - Background: The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure. Methods: We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization. Results: Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99-1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04-1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86-1.04) P = 0.26; P for interaction 0.005). Conclusions: The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration. Trial registration ClinicalTrials.gov
KW - Blood pressure
KW - Coronary artery disease
KW - Diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85092539892&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85092539892&partnerID=8YFLogxK
U2 - 10.1186/s12933-020-01150-0
DO - 10.1186/s12933-020-01150-0
M3 - Article
C2 - 33046070
AN - SCOPUS:85092539892
VL - 19
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
IS - 1
M1 - 175
ER -
