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Systolic blood pressure and risk of cardiovascular disease in normotensive diabetic adults: a prospective cohort study

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Abstract

Background

Currently, the special blood pressure (BP) target for normotensive diabetic patients has not been recommended. We investigated the optimal systolic blood pressure (SBP) for lower cardiovascular disease (CVD) risk in normotensive diabetic patients.

Methods

In this 12-year follow-up study using the participants of the Kailuan Study, we mainly compared which SBP, 90–119 mmHg or 120–129 mmHg, had a lower risk of occurrence of CVD (stroke and myocardial infarction) in the 3072 normotensive diabetic participants and 21,532 normotensive and non-diabetic participants, respectively. The SBP was expressed as a mean time-weighted cumulative (MTWC) SBP, calculated from the multiple measurements of SBP during the follow-up. Multivariate competing risk regression analyses were used for the analysis.

Results

We found that in normotensive diabetic participants, MTWC SBP of 120–129 mmHg was associated with a lower risk of CVD (HR = 0.69 [0.50–0.95]), myocardial infarction (HR = 0.48 [0.24–0.96]), and trending towards lower risk of stroke (HR = 0.80 [0.55–1.16]), compared to MTWC SBP of 90–119 mmHg. Sensitivity analyses confirmed the relationship between low SBP and increased CVD risk. Whereas, in the normotensive and non-diabetic participants, MTWC SBP of 90–119 mmHg vs 120–129 mmHg did not exhibit any difference in the risk of CVD occurrence (HR = 0.99 [0.83–1.18]).

Conclusions

The higher level of SBP in normotensive diabetic patients is especially associated with a lower risk of CVD occurrence.

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Acknowledgements

We thank all the survey teams of the Kailuan Study group for their contribution and the study participants who contributed their information.

Funding

The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This study was supported by National Key Research and Development Program of China (2022YFC3600600), Bei**g Natural Science Foundation Haidian original innovation joint fund (L222123), Fund for Young Talents of Bei**g Medical Management Center (QML20230505), and the high-level public health talents (xuekegugan-02-47).

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Authors and Affiliations

  1. Department of Neurology, Xuanwu Hospital, Capital Medical University, Bei**g, China

    Yingting Zuo

  2. Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China

    Shuohua Chen & Shouling Wu

  3. Department of Epidemiology, Bei**g Neurosurgical Institute, Bei**g Tiantan Hospital, Capital Medical University, Bei**g, China

    Xue Tian & Anxin Wang

  4. Department of Clinical Epidemiology and Clinical Trial, Capital Medical University,, Bei**g, China

    Xue Tian & Anxin Wang

  5. Bei**g Municipal Key Laboratory of Clinical Epidemiology, Bei**g, China

    Xue Tian & Anxin Wang

Authors
  1. Yingting Zuo
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  2. Shuohua Chen
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  3. Xue Tian
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  4. Shouling Wu
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  5. Anxin Wang
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Contributions

Y.Z. wrote the manuscript. S.C. participated in the data analysis. X.T. participated in the literature search. S.C. participated in the data collection, study management and study coordination. A.W. edited the English in the manuscript. S.W. and A.W. contributed to the discussion, and also reviewed and edited the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Shouling Wu or Anxin Wang.

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Conflict of interest

The authors declare no competing interests.

Ethics approval

This study was approved by the Ethics Committees of Kailuan General Hospital (approval number: 2006-05) and the Bei**g Tiantan Hospital (approval number: 2010-014-01).

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Zuo, Y., Chen, S., Tian, X. et al. Systolic blood pressure and risk of cardiovascular disease in normotensive diabetic adults: a prospective cohort study. Endocrine (2024). https://doi.org/10.1007/s12020-024-03803-6

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