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Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin.

Publication ,  Journal Article
Navar, AM; Gallup, DS; Lokhnygina, Y; Green, JB; McGuire, DK; Armstrong, PW; Buse, JB; Engel, SS; Lachin, JM; Standl, E; Van de Werf, F ...
Published in: Hypertension
November 2017

Systolic blood pressure (SBP) treatment targets for adults with diabetes mellitus remain unclear. SBP levels among 12 275 adults with diabetes mellitus, prior cardiovascular disease, and treated hypertension were evaluated in the TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin) randomized trial of sitagliptin versus placebo. The association between baseline SBP and recurrent cardiovascular disease was evaluated using multivariable Cox proportional hazards modeling with restricted cubic splines, adjusting for clinical characteristics. Kaplan-Meier curves by baseline SBP were created to assess time to cardiovascular disease and 2 potential hypotension-related adverse events: worsening kidney function and fractures. The association between time-updated SBP and outcomes was examined using multivariable Cox proportional hazards models. Overall, 42.2% of adults with diabetes mellitus, cardiovascular disease, and hypertension had an SBP ≥140 mm Hg. The association between SBP and cardiovascular disease risk was U shaped, with a nadir ≈130 mm Hg. When the analysis was restricted to those with baseline SBP of 110 to 150 mm Hg, the adjusted association between SBP and cardiovascular disease risk was flat (hazard ratio per 10-mm Hg increase, 0.96; 95% confidence interval, 0.91-1.02). There was no association between SBP and risk of fracture. Above 150 mm Hg, higher SBP was associated with increasing risk of worsening kidney function (hazard ratio per 10-mm Hg increase, 1.10; 95% confidence interval, 1.02-1.18). Many patients with diabetes mellitus have uncontrolled hypertension. The U-shaped association between SBP and cardiovascular disease events was largely driven by those with very high or low SBP, with no difference in cardiovascular disease risk between 110 and 150 mm Hg. Lower SBP was not associated with higher risks of fractures or worsening kidney function.

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Published In

Hypertension

DOI

EISSN

1524-4563

Publication Date

November 2017

Volume

70

Issue

5

Start / End Page

907 / 914

Location

United States

Related Subject Headings

  • Sitagliptin Phosphate
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
  • Hypoglycemic Agents
  • Hypertension
  • Humans
 

Citation

APA
Chicago
ICMJE
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Navar, A. M., Gallup, D. S., Lokhnygina, Y., Green, J. B., McGuire, D. K., Armstrong, P. W., … TECOS Study Group, . (2017). Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin. Hypertension, 70(5), 907–914. https://doi.org/10.1161/HYPERTENSIONAHA.117.09482
Navar, Ann Marie, Dianne S. Gallup, Yuliya Lokhnygina, Jennifer B. Green, Darren K. McGuire, Paul W. Armstrong, John B. Buse, et al. “Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin.Hypertension 70, no. 5 (November 2017): 907–14. https://doi.org/10.1161/HYPERTENSIONAHA.117.09482.
Navar AM, Gallup DS, Lokhnygina Y, Green JB, McGuire DK, Armstrong PW, et al. Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin. Hypertension. 2017 Nov;70(5):907–14.
Navar, Ann Marie, et al. “Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin.Hypertension, vol. 70, no. 5, Nov. 2017, pp. 907–14. Pubmed, doi:10.1161/HYPERTENSIONAHA.117.09482.
Navar AM, Gallup DS, Lokhnygina Y, Green JB, McGuire DK, Armstrong PW, Buse JB, Engel SS, Lachin JM, Standl E, Van de Werf F, Holman RR, Peterson ED, TECOS Study Group. Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin. Hypertension. 2017 Nov;70(5):907–914.

Published In

Hypertension

DOI

EISSN

1524-4563

Publication Date

November 2017

Volume

70

Issue

5

Start / End Page

907 / 914

Location

United States

Related Subject Headings

  • Sitagliptin Phosphate
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
  • Hypoglycemic Agents
  • Hypertension
  • Humans