The Effects of Age, Diabetes & High Systolic Blood Pressure

Researchers found that every ten mmHg increase in systolic blood pressure observed was associated with an increased risk of cardiovascular diseases, and diabetes worsens risk.

While most international guidelines explain the importance of regulating systolic blood pressure, there is no agreement on systolic blood pressure goals. To close this knowledge gap, a team of Hong Kong doctors conducted a detailed group study of association with age and specific risk factors of systolic blood pressure and cardiovascular disease in patients with type 2 diabetes. This research analyzed more than 175,000 Chinese patients by having clinicians review the age-related risk of diseases commonly associated with high blood pressure and multiple cardiovascular diseases, especially in patients with type 2 diabetes. The study was explicitly done in the Asian population.   

The study showed significant results in that increase of blood pressure only by ten mmHg above 120 mmHg was linked to an increased risk of cardiovascular disease by 11%, and increased by 20% in patients with type 2 diabetes in addition to hypertension risk.  

The retrospective cohort study was conducted in patients who were diagnosed with type 2 diabetes and between the ages of 18-79. The patients were monitored and followed up in and managed in public primary care clinics in Hong Kong throughout the study duration of 2 years. Patients with a prior diagnosis of CVD at baseline were excluded. The patient diagnosis with type 2 diabetes mellitus was done by the doctors recruited in the research. The source of all baseline and outcome measures was from the Hong Kong clinical management system’s electronic health database. 

The population-based cohort retrospective study was the first to identify an age-specific positive and logarithmic relationship between SBP and CVD, coronary heart disease, stroke, heart failure, and CVD-related mortality in Chinese DV patients. The primary goal of the researchers’ analysis is the combined endpoints for cardiovascular disease and cardiovascular disease death. The study’s secondary outcome was independent cardiovascular disease, including subtypes of coronary heart disease, stroke, heart failure, and cardiovascular disease-related deaths. 

Using data from the Hong Kong Hospital, investigators identified a group of 180,492 patients to include in their analysis. In the analysis, patients between the ages of 18 and 79 have been medically diagnosed with type 2 diabetes and treated in Hong Kong clinics from 2008 to 2010. Significantly, patients with a previous diagnosis of cardiovascular disease were excluded at the beginning of the study. 

Baseline covariates included in the analysis were gender, age, smoking status, BMI, glycated hemoglobin, LDL cholesterol, eGFR, Charlson comorbidity index, and the use of ACE inhibitors or ARBs. 

To make the analysis easier to interpret, patients were categorized into seven groups based on systolic blood pressure. These groups were defined as under 120 mmHg, 120-129, 130-139, 140-149, 150-159, 160-169, and 170 mmHg or greater. 

During the 1.5-million-year follow-up, which corresponds to a mean follow-up of 9.3 years, 32,545 patients developed cardiovascular disease. Based on this, the incidence of the study cohort was 23.4 per 1,000 person-years. 

The researchers’ analysis results indicate a positive association between systolic blood pressure and heart disease in the four age groups. However, as the age group increased, the magnitude of this effect decreased. It was observed that the risk of a heart attack in people under the age of 50 was 22% higher than between the ages of 70 and 79. 

Overall, the results showed that every ten mmHg increase in systolic blood pressure observed was associated with an increased risk of all complex cardiovascular diseases by 12% (heart rate, 1.12; 95% CI, 1.10-1.13), an increased risk of some cardiovascular diseases by 11% (HR, 1.11; 95% CI, 1.10-1.13) and a 20% higher risk of cardiovascular disease mortality (H.R., 1.20; 95% CI, 1.17-1, 22). The researchers noted many limitations in their study that clinicians should consider when interpreting the data and called for more research to explore these potential associations. “The results of this study suggest that younger patients and smokers may benefit the most from a lower B.P. target, and therefore an individualized target SBP in diabetic patients without CVD may be appropriate. RCTs are needed to validate our results,” the investigators wrote. 

Practice Pearls: 

• The research proved an increase in blood pressure and diabetes increased the risk of cardiovascular diseases. 
• Depending on the age group, the risk of cardiovascular disease could increase, especially in type 2 diabetes patients. 
• More research is needed to prove the association between hypertension and diabetes. 

Wan, E., Eric Yuk Fai Wan, Age‐Specific Associations Between Systolic Blood Pressure and Cardiovascular Disease: The Journal of the American Heart Association  

Olivia Shenouda, Fourth Year Doctor of Pharmacy Candidate, Florida A&M University