Blood Pressure and Cardiovascular Disease Risk in the Veterans Affairs Diabetes Trial
Open accessAbstract
OBJECTIVE: Blood pressure ranges associated with cardiovascular disease (CVD) events in advanced type 2 diabetes are not clear. Our objective was to determine whether baseline and follow-up (On-Study) systolic blood pressure (SBP), diastolic blood pressure (DBP), and SBP combined with DBP predict CVD events in the Veterans Affairs Diabetes Trial (VADT). RESEARCH DESIGN AND METHODS: Participants in the VADT (n = 1,791) with hypertension received stepped treatment to maintain blood pressure below the target of 130/80 mmHg in standard and intensive glycemic treatment groups. Blood pressure levels of all subjects at baseline and On-Study were analyzed to detect associations with CVD risk. The primary outcome was the time from randomization to the first occurrence of myocardial infarction, stroke, congestive heart failure, surgery for vascular disease, inoperable coronary disease, amputation for ischemic gangrene, or CVD death. RESULTS: Separated SBP ≥140 mmHg had significant risk at baseline (hazards ratio [HR] 1.508, P < 0.001) and On-Study (HR 1.469, P = 0.002). DBP <70 mmHg increased CVD events at baseline (HR 1.482, P < 0.001) and On-Study (HR 1.491, P < 0.001). Combined blood pressure categories indicated high risk for CVD events for SBP ≥140 with DBP <70 mmHg at baseline (HR 1.785, P = 0.03) and On-Study (HR 2.042, P = 0.003) and nearly all SBP with DBP <70 mmHg. CONCLUSIONS: Increased risk of CVD events with SBP ≥140 mmHg emphasizes the urgency for treatment of systolic hypertension. Increased risk with DBP <70 mmHg, even when combined with SBP in guideline-recommended target ranges, supports a new finding in patients with type 2 diabetes. The results emphasize that DBP <70 mmHg in these patients was associated with elevated CVD risk and may best be avoided.
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A post-hoc analysis of the cohort of participants with diabetes in the INVEST trial, whose mean age was about 65 years, showed that achieved SBP under 130 mmHg was not associated with improved cardiovascular outcomes compared with SBP under 140 mmHg.
“A post-hoc analysis of the cohort of participants with diabetes in the INVEST trial, whose mean age was about 65 years, showed that achieved SBP under 130 mmHg was not associated with improved cardiovascular outcomes compared with SBP under 140 mmHg47.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [47]
A post-hoc analysis of the VADT trial showed that those whose SBP was ≥140 mm Hg had increased mortality, while those at <105 mm Hg, 105-129 mm Hg, and 130-139 mm Hg had equally low mortality rates; for diastolic BP, achieved values <70 mm Hg were associated with higher mortality, while those of 70-79 mm Hg or >80 mm Hg were equally low.
“A post-hoc analysis of the VADT trial (in which the goal BP was < 130/80 mm Hg) showed, similarly, that those whose SBP was ≥ 140 mm Hg had increased mortality, while those at < 105 mm Hg, 105–129 mm Hg, and 130–139 mm Hg had equally low mortality rates. For diastolic BP, achieved values < 70 mm Hg were associated with higher mortality, while those of 70–79 mm Hg or > 80 mm Hg were equally low48.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [48]
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References 23 · Cited by 93
- Authors
- Anderson, R. J., Bahn, G. D., Moritz, T. E., Kaufman, D., Abraira, C., Duckworth, W., & for the VADT Study Group
- Affiliations
- Omaha VA Medical Center (US)
- Edward Hines, Jr. VA Hospital (US)
- Miami VA Healthcare System (US)
- Phoenix VA Health Care System (US)
- Corresponding author
- Anderson, Robert J.
- ORCID
- Moritz, Thomas E.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2010-11-08
- Volume
- 34
- Issue
- 1
- Pages
- 34-38
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3005453
- OpenAlex
- W2149674228
- Cited by
- 93
- References
- 23
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 4 · 2017: 4 · 2016: 7 · 2015: 15 · 2014: 6 · 2013: 10 · 2012: 13
- FWCI
- 6.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association
- U.S. Department of Veterans Affairs
- GlaxoSmithKline
- Sanofi
- Office of Research and Development
- Novo Nordisk
- National Institutes of Health
- National Eye Institute
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- blood pressure, cardiovascular risk, type 2 diabetes, systolic blood pressure, diastolic blood pressure, hypertension, cardiovascular events, tight glycemic control, myocardial infarction, stroke, congestive heart failure
- MeSH terms
- Aged, Blood Pressure, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged
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