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

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.

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.

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]).

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