Proteinuria modifies the effect of systolic blood pressure on total and cardiovascular disease mortality in patients with type 2 diabetes
Article first published online: 24 SEP 2012
© 2012 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 272, Issue 6, pages 611–619, December 2012
How to Cite
Proteinuria modifies the effect of systolic blood pressure on total and cardiovascular disease mortality in patients with type 2 diabetes. J Intern Med 2012; 10.1111/j.1365-2796.2012.02581.x., , , , , Turku University Hospital, University of Turku, Turku; and Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
- Issue published online: 20 NOV 2012
- Article first published online: 24 SEP 2012
- Accepted manuscript online: 14 AUG 2012 09:58AM EST
- cardiovascular disease;
- diabetes complications;
- systolic blood pressure;
- type 2 diabetes
Hypertension and proteinuria are major risk factors for cardiovascular disease (CVD) mortality in patients with type 2 diabetes. Blood pressure (BP) targets have been progressively lowered in these patients to prevent or delay the progression of nephropathy. However, no long-term population-based studies have been reported on the interaction between BP and proteinuria with respect to total and CVD mortality in patients with type 2 diabetes.
We prospectively followed 881 middle-aged type 2 diabetic patients, free of CVD events at baseline, for up to 18 years. Participants were categorized into four groups according to baseline systolic BP (<130, 130–139, 140–159 and ≥160 mmHg) and further stratified by proteinuria (≤150 or >150 mg L−1). Cox proportional hazards model was used to estimate the joint association between systolic BP and proteinuria and the risk of mortality.
During follow-up, 607 patients died including 395 because of CVD. After adjustment for confounding factors, total and CVD mortality were significantly higher in patients with proteinuria and systolic BP <130 mmHg compared with those with systolic BP between 130 and 160 mmHg. The prognosis was similar in patients with systolic BP <130 mmHg or ≥160 mmHg. Among patients without proteinuria, systolic BP <130 mmHg was associated with a nonsignificant reduction in mortality.
Type 2 diabetic patients with proteinuria and with systolic BP <130 mmHg may have an increased risk of CVD mortality. The presence of proteinuria should be taken into account when defining the target systolic BP level for the prevention of fatal CVD events in patients with type 2 diabetes.