Target home morning SBP be below 125 mmHg in type 2 diabetes patients.

BACKGROUND: It is not established to what extent self-monitoring of home BP be lowered in patients with type 2 diabetes. We tested the hypothesis that the appropriate home morning SBP cutoff value is 125 mmHg in our stratification of cardiovascular risk in type 2 diabetes.

METHOD: Clinic and home BP monitoring were performed in 4308 individuals (1057 people with diabetes and 3251, nondiabetes), and we tested two cutoff values of home morning SBP (MSBP): 135 and 125 mmHg. Multivariable Cox regression analyses adjusting for age, sex, body mass index, history of cardiovascular events, presence of chronic kidney disease, and atrial fibrillation were used for incident cardiovascular events. Main outcomes included stroke, myocardial infarction, sudden death, and acute aortic dissection.

RESULTS: A Kaplan-Meyer analysis revealed that MSBP at least 135 mmHg was significantly associated with cardiovascular events in both diabetes and nondiabetes groups (log-rank test, both P < 0.01), whereas MSBP at least 125 mmHg was significantly associated with cardiovascular events in the diabetes group (P = 0.012) but not nondiabetes group. In a multivariable analysis, home MSBP at least 135 mmHg was significantly associated with cardiovascular events in the diabetes group [hazard ratio 2.45, 95% confidence interval (CI) 1.17-5.14, P = 0.017) and nondiabetes group (hazard ratio 1.79, 95% CI 1.08-2.97, P = 0.024). Home MSBP at least 125 mmHg was an independent predictor of cardiovascular events in the diabetes group (hazard ratio 4.35, 95% CI 1.04-18.25, P = 0.045) but not in the nondiabetes group.

CONCLUSION: In patients with type 2 diabetes, the 125-mmHg cutoff value for home MSBP would be the appropriate cutoff value in predicting combined cardiovascular outcomes.