Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial
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ORIGINAL INVESTIGATION
Cardiovascular Diabetology Open Access
Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial Magnus O. Wijkman1,2* , Brian Claggett1, Rafael Diaz3, Hertzel C. Gerstein4, Lars Køber5, Eldrin Lewis6, Aldo P. Maggioni7,8, Emil Wolsk5, David Aguilar9, Rhonda Bentley‑Lewis10, John J. McMurray11, Jeffrey Probstfield12, Matthew Riddle13, Jean‑Claude Tardif14, Scott D. Solomon1 and Marc A. Pfeffer1
Abstract Background: The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure. Methods: We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization. Results: Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99–1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04–1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86–1.04) P = 0.26; P for interaction 0.005). Conclusions: The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration. Trial registration ClinicalTrials.gov number NCT01147250, first posted June 22, 2010 Keywords: Diabetes mellitus, Coronary artery disease, Blood pressure Background Elevated blood pressure is considered an important additive risk factor in patients with type 2 diabetes, augmenting the already heightened risk for morbidity and *Correspondence: [email protected]; [email protected] 1 Cardiovascular Division, Brigham & Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA Full list of author information is available at the end of the article
mortality in these patients [1]. However, there is ongoing controversy regarding the optimal blood pressure treatment targets [2], and current guidelines provide differing recommendations [3–5]. I
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