Associations of blood pressure with cardiovascular and mortality outcomes in over 2 million older persons with or without diabetes mellitus: A systematic review and meta-analysis of 45 cohort studies

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes Pub Date : 2023-12-01 DOI:10.1016/j.pcd.2023.09.007

Samuel Seidu , Clare E. Hambling , Setor K. Kunutsor , Pinar Topsever

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Abstract

Background

The impact of blood pressure on cardiovascular disease (CVD) and mortality outcomes in older people with diabetes mellitus (DM) is not well quantified. Using a systematic review and meta-analysis of observational cohort studies, we aimed to compare the associations of blood pressure levels with cardiovascular and mortality outcomes in older people aged ≥ 65 years with or without DM.

Methods

Studies were identified from MEDLINE, Embase, Web of Science, and search of bibliographies to July 2022. Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled.

Results

Forty-five unique observational cohort studies (n = 2305,189 participants) assessing the associations of systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) levels with adverse cardiovascular outcomes were included. In the general population, the pooled RRs (95% CIs) of SBP ≥ 140 vs < 140 mmHg and per 10 mmHg increase for composite CVD/MACE were 1.26 (0.96–1.64) and 1.15 (1.08–1.23), respectively. The respective estimates were 1.56 (1.04–2.34) and 1.10 (1.04–1.18) for patients with DM. SBP ≥ 130 vs < 130 mmHg was not associated with an increased risk of adverse cardiovascular outcomes in both populations. SBP < 120 vs ≥ 120 mmHg was associated with an increased risk of all cause-mortality in the general population (n = 10 studies). DBP ≥ 90 mmHg was associated with an increased risk of some adverse cardiovascular outcomes in both populations. Interaction analyses suggested similar risk of outcomes in both populations.

Conclusions

Observational evidence suggests SBP and DBP confer similar cardiovascular and mortality risk in older adults in the general population and those with DM. A blood pressure target range of > 130/80 to < 140/90 mmHg may be optimal for patients ≥ 65 years with DM, but specific targets may need to be individualised based on patients’ unique circumstances. Furthermore, findings do not support stringent blood pressure control in this population group. Definitive RCTs are needed to support these observational findings.

查看原文本刊更多论文

200多万患有或不患有糖尿病的老年人的血压与心血管和死亡率的相关性：对45项队列研究的系统综述和荟萃分析。

背景：血压对老年糖尿病患者心血管疾病（CVD）和死亡率的影响尚未得到很好的量化。通过对观察性队列研究的系统回顾和荟萃分析，我们旨在比较年龄≥65岁的老年人（无论是否患有糖尿病）的血压水平与心血管和死亡率结果的相关性。方法：研究从MEDLINE、Embase、Web of Science和2022年7月的文献检索中确定。合并了具有95%置信区间（CI）的研究特异性风险比（RR）。结果：纳入了45项独特的观察性队列研究（n=2305189名参与者），评估了收缩压（SBP）和/或舒张压（DBP）水平与不良心血管结局的关系。在普通人群中，收缩压≥140的合并RR（95%CI）与结论：观察证据表明，收缩压和舒张压在普通人群和糖尿病患者中老年人的心血管和死亡率风险相似。血压目标范围>130/80至

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来源期刊

Primary Care Diabetes ENDOCRINOLOGY & METABOLISM-PRIMARY HEALTH CARE

CiteScore

5.00

自引率

3.40%

发文量

134

审稿时长

47 days

期刊介绍： The journal publishes original research articles and high quality reviews in the fields of clinical care, diabetes education, nutrition, health services, psychosocial research and epidemiology and other areas as far as is relevant for diabetology in a primary-care setting. The purpose of the journal is to encourage interdisciplinary research and discussion between all those who are involved in primary diabetes care on an international level. The Journal also publishes news and articles concerning the policies and activities of Primary Care Diabetes Europe and reflects the society''s aim of improving the care for people with diabetes mellitus within the primary-care setting.