Complex Relationship Between Blood Pressure and Mortality in Type 2 Diabetic Patients: A Follow-Up of the Botnia Study

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 47; no. 2; pp. 168 - 173
• Main Authors: Rönnback, Mats, Isomaa, Bo, Fagerudd, Johan, Forsblom, Carol, Groop, Per-Henrik, Tuomi, Tiinamaija, Groop, Leif
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01-02-2006; Hagerstown, MD Lippincott
• Subjects: Age Factors; Aged; Aged, 80 and over; Antihypertensive agents; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Cardiac and Cardiovascular Systems; Cardiology. Vascular system; cardiovascular diseases; Cardiovascular Diseases - complications; Cardiovascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Clinical Medicine; Cohort Studies; diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - physiopathology; Diastole; elderly; Female; Follow-Up Studies; Humans; Kardiologi; Klinisk medicin; Male; Medical and Health Sciences; Medical Records; Medical sciences; Medicin och hälsovetenskap; Middle Aged; mortality; Pharmacology. Drug treatments; Risk Factors; Systole; Endocrinopathy; Type 2 diabetes; Human; Hypertension; Heart failure; Systolic pressure; risk factors; Diastolic pressure; Mortality; Metabolic diseases; Cardiovascular disease; diabetes mellitus; cardiovascular diseases; Follow up study; Heart disease; Risk factor; Arterial pressure; Blood pressure; Stiffness; Elderly
• ISSN: 0194-911X; 1524-4563; 1524-4563
• DOI: 10.1161/01.HYP.0000199667.30253.b7

The presence of hypertension aggravates the high cardiovascular risk in type 2 diabetic patients. Pulse pressure is a marker of arterial stiffness and constitutes a risk factor for cardiovascular mortality. This study examines the relationship between different blood pressure indices and mortality in a cohort of type 2 diabetic patients. A total of 1294 type 2 diabetic patients with a median age of 69.1 years participated in the Botnia Study from 1990 to 1997. In 2004, after a median follow-up of 9.5 years, data on mortality was collected from the national population registry and hospital records. Systolic and diastolic blood pressure correlated negatively with mortality after adjustment for other risk factors. The association between low systolic and diastolic blood pressure and mortality was pronounced in patients with previous cardiovascular disease. A U-shaped association between pulse pressure and mortality was observed in elderly patients. These observations could be linked to arterial stiffness and heart failure. Low blood pressure in high-risk patients is likely to be a marker of poor health rather than the cause of mortality. The results suggest that the role of blood pressure as a risk marker in elderly type 2 diabetic patients with cardiovascular disease needs to be reevaluated.