Blood Pressure and Development of Cardiovascular Disease in Koreans With Type 2 Diabetes Mellitus

Abstract

The objective of this study was to investigate the optimal blood pressure (BP) target to prevent development of cardiovascular diseases (CVDs) in Korean subjects with type 2 diabetes mellitus. Using the Korean National Health Insurance Service database, 2262725 subjects with type 2 diabetes mellitus who underwent regular health checks between 2009 and 2012 were included. Subjects with previous CVDs were excluded. Participants were grouped by 10-mmHg intervals of observed systolic BP (SBP) by 5-mmHg intervals of diastolic BP. There were 124466 deaths (5.50%), 67235 cases of stroke (2.97%), and 41726 myocardial infarctions (1.84%) during a median follow-up of 6.5 years. Compared with SBP 110 to 119 mmHg, there was no increased risk among subjects with SBP 120 to 129 mmHg, but SBP 130 mmHg was associated with a significant increase in the incidence of CVDs. SBP 130 to 139 mmHg was associated with a significant increase in the incidence of stroke (hazard ratio, 1.15; 95% CI, 1.12-1.18) and myocardial infarctions (hazard ratio, 1.05; 95% CI, 1.02-1.09) compared with SBP 110 to 119 mmHg. Subjects with diastolic BP 80 to 84 mmHg had a higher risk of CVDs than subjects with diastolic BP 75 to 79 mmHg. The overall relationship between BP and CVD risk was positive, with a greater strength observed for younger age groups. The optimal cutoff for Korean patients with type 2 diabetes mellitus associated with lower CVD risk may be 130 mmHg for SBP or 80 mmHg for diastolic BP.