Cumulative blood pressure predicts risk of stroke in individuals with type 2 diabetes

Rukai Yang; Hejun Jiang; Zhenhua Xing; Huiqing Ding; Zhiyi Yin; Liyao Fu; Shi Tai

doi:10.1016/j.dsx.2024.102988

Cumulative blood pressure predicts risk of stroke in individuals with type 2 diabetes

Diabetes Metab Syndr. 2024 Mar 15;18(3):102988. doi: 10.1016/j.dsx.2024.102988. Online ahead of print.

Authors

Rukai Yang¹, Hejun Jiang¹, Zhenhua Xing¹, Huiqing Ding¹, Zhiyi Yin², Liyao Fu³, Shi Tai⁴

Affiliations

¹ Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China.
² Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.
³ Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China. Electronic address: fuliyao2017@csu.edu.cn.
⁴ Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China. Electronic address: taishi2017@csu.edu.cn.

PMID: 38513321
DOI: 10.1016/j.dsx.2024.102988

Abstract

Aims: To determine whether cumulative blood pressure (BP) could predict stroke in individuals with type 2 diabetes (T2D).

Methods: BP levels at baseline and the initial three visits were obtained from individuals participating in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial who had not experienced a stroke. Cumulative elevations in BP were assessed by adding the weighted mean BP values at various time intervals. The association of cumulative BP with stroke was evaluated by a multivariate-adjusted Cox proportional hazard model analysis.

Results: Overall, 8282 participants were included (62.10% males and 37.90% females; mean age, 62.73 years). With a median follow-up period of 6.36 years, 324 (3.91%) and 305 (3.68%) patients had any and nonfatal stroke events, respectively. Only baseline systolic BP (SBP) independently predicted any stroke after adjustment for potential confounders, whereas cumulative SBP and pulse pressure independently predicted elevated stroke events. A strong dose-response relationship between cumulative BP and stroke was identified, and conventional risk factors combined with cumulative SBP improved prediction efficiency.

Conclusion: Cumulative SBP independently predicts stroke in individuals with T2D and provides an incremental predictive value for stroke compared with baseline BP assessments.

Trial registration: URL: http://www.

Clinicaltrials: gov. Unique identifier: NCT00000620).

Keywords: Blood pressure; Cardiovascular diseases; Cumulative exposure; Hypertension; Stroke; Type 2 diabetes.

Associated data

ClinicalTrials.gov/NCT00000620