Relationship between BP, CV risk similar regardless of diabetes status

Redon J. J Am Coll Cardiol. 2012;59:74-83.

Issue: March 2012

Researchers found a similar pattern in the relationship between BP and overall CV risk among patients with and without diabetes over a wide range of BP values.

Using data from the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET), researchers conducted a post hoc analysis to determine whether BP levels at which CV protection is achieved are different in patients with and without diabetes. The trial included more than 25,000 patients who were assigned to ramipril (Altace, King Pharmaceuticals), telmisartan (Micardis, Boehringer Ingelheim) or both for a median follow-up of 4.6 years. Enrolled patients were aged 55 years or older, had one or more previous CV event and/or had diabetes with end-organ damage.

Analysis showed that the primary outcome of CV death, nonfatal MI or stroke or hospitalized HF occurred in 20.2% of patients with diabetes vs. 14.2% without diabetes. Not only did patients with diabetes have a significantly higher risk for the primary composite outcome (HR=1.48; 95% CI, 1.38-1.57), but also were at greater risk for CV death (HR=1.56; 95% CI, 1.42-1.71), MI (HR=1.30; 95% CI, 1.17-1.46), stroke (HR=1.39; 95% CI, 1.23-1.56) and congestive HF hospitalization (HR=2.06; 95% CI, 1.82-2.32) compared with patients without diabetes.

The researchers also studied whether BP reduction in high-risk patients with diabetes affected outcomes differently than patients without diabetes. Regardless of changes in systolic BP during treatment, results showed a significantly higher CV risk with the presence of diabetes. However, reduced risk for the primary composite outcome accompanied greater reductions in systolic BP among both groups of patients, but only if baseline systolic BP levels ranged from 143 mm Hg to 155 mm Hg. With the exception of stroke, researchers found no benefit in fatal or nonfatal CV outcomes by reducing systolic BP to less than 130 mm Hg.

“This confirms the results of previous studies that diabetes sharply increases CV risk and that this occurs regardless of the BP level. It also shows that diabetes continues to magnify CV risk, even in patients at high CV risk for other reasons,” the researchers wrote in the study.

Disclosure: The ONTARGET trial was funded by Boehringer Ingelheim. Researchers for this analysis report various relevant financial disclosures with Boehringer Ingelheim and other companies.

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