Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27, 732 patients based on the Swedish National Diabetes Register. (May 2017)

• Record Type: Journal Article
• Authors: Svensson, Maria K; Afghahi, Henri; Franzen, Stefan; Björk, Staffan; Gudbjörnsdottir, Soffia; Svensson, Ann-Marie; Eliasson, Björn
• Is Part Of: Diabetes & vascular disease research. Volume 14:Number 3(2017:May)
• Page Start: 226
• Page End: 235
• Publication Date: 2017-05
• Subjects: Type 2 diabetes -- renal impairment -- blood pressure -- cardiovascular outcomes -- all-cause mortality; Diabetic angiopathies -- Periodicals; 616.462005
• DOI: 10.1177/1479164116683637
• Languages: English
• ISSNs: 1479-1641

Abstract

Background: Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. Aims: To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. Patients and methods: A total of 27, 732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. Results: A time-updated systolic blood pressure < 130 mmHg was associated with a higher risk of all-cause mortality in patients both with and without a history of chronic heart failure (hazard ratio: 1.25, 95% confidence interval: 1.13–1.40 and hazard ratio: 1.26, 1.17–1.36, respectively). A time-updated decrease in systolic blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (−10 to −25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17–1.32). Conclusion: Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.