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BP guidelines too high for preventing CAD in type 1 diabetes

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SAN FRANCISCO — Having blood pressure of more than 120/80 mm Hg combined with HbA1c of more than 8% makes coronary artery disease three times more likely to manifest for those with type 1 diabetes developed during childhood compared with those with lower measures, according to findings presented at the American Diabetes Association Scientific Sessions.

“Currently, the American Diabetes Association recommends a blood pressure goal of 140/90 [mm Hg] for diabetes individuals with lower heart disease risk and 130/80 [mm Hg] for those with existing heart disease or those with higher risk,” Jingchuan Guo, MD, PhD, a postdoctoral fellow at the Center of Pharmaceutical Policy and Prescribing (CP3) at the University of Pittsburgh, said during a press conference. “There’s no clinical trial data available to guide blood pressure management goals in young adults with type 1 diabetes.”

For Guo and colleagues’ analysis, 605 individuals with childhood-onset type 1 diabetes (mean age, 27 years) from the Pittsburgh Epidemiology of Diabetes Complications study were recruited between 1986 and 1988. Guo said participants did not have heart disease upon recruitment and were followed for 25 years with biennial surveys and exams at years 2, 4, 6, 8, 10, 18 and 25, with the final exam occurring between 2011 and 2014. The researchers also performed statistical analysis to identify the risk for CAD at differing levels of BP, ultimately concluding 120/80 mm Hg was the ideal threshold, with CAD 1.9 times more likely for those with measures at or above this mark (95% CI, 1.4-2.6) compared with those with lower BP measures.

Having blood pressure of more than 120/80 mm Hg combined with HbA1c of more than 8% makes coronary artery disease three times more likely to manifest for those with type 1 diabetes developed during childhood compared with those with lower measures.

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Participants who had BP of greater than 120/80 mm Hg and HbA1c measures of more than 8% were 3.1 times more likely to develop CAD (95% CI, 1.7-5.6) compared with those with lower measures of both. Compared with those with BP of less than 120/80 mm Hg and HbA1c of less than 8%, Guo said those with just high BP (HR = 2; 95% CI, 1.04-3.8) and just high HbA1c (HR = 1.7; 95% CI, 0.99-1.9) had “similar risk for heart disease.”

“Our study suggests optimal blood pressure goals need to be lower than current[ly] recommended to further reduce the risk in this group of patients,” Guo said. “Young adults with type 1 diabetes should have careful monitoring of their blood pressure [and], because of the absence of direct randomized clinical trial data, our findings should be carefully considered in clinical settings.” – by Phil Neuffer

Reference:

Guo J, et al. 1464-P. Optimal blood pressure goals for cardiovascular health in individuals with type 1 diabetes. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco.

Disclosure: Guo reports no relevant financial disclosures.