Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study.
Bragg F., Halsey J., Guo Y., Zhang H., Yang L., Sun X., Pei P., Chen Y., Du H., Yu C., Clarke R., Lv J., Chen J., Li L., Chen Z., China Kadoorie Biobank (CKB) collaborative group (members listed in Supplementary appendix) None.
Background: Controversy persists about the relationship of blood pressure with cardiovascular diseases (CVD) in diabetes and associated disease burden. We assessed these associations among Chinese adults with type 2 diabetes (T2D). Methods: In 2004-08, the China Kadoorie Biobank recruited >512,000 adults aged 30-79 years from 10 localities across China, including 26,315 with T2D (based on self-report or plasma glucose measurement) but no prior CVD, followed-up for ~9 years. Cox regression yielded adjusted HR for major CVD and all-cause mortality associated with 10 mmHg higher usual (longer-term average) SBP. Attributable fractions were estimated to assess cardiovascular mortality burden due to uncontrolled hypertension (SBP ≥130 mmHg or DBP ≥80 mmHg). Findings: Overall, 75.7% of participants had self-reported (24.8%) or screen-detected (50.9%) (SBP ≥130 mmHg or DBP ≥80 mmHg) hypertension. Among individuals with self-reported hypertension, 82.3% were treated, of whom 9.3% achieved control. There were positive log-linear associations of blood pressure with CVD, with no evidence of a threshold down to ~120 mmHg for usual SBP. Each 10 mmHg higher usual SBP was associated with HR of 1.28 (95% CI 1.25-1.30), 1.18 (1.15-1.21), 1.17 (1.15-1.19) and 1.45 (1.38-1.52) for cardiovascular death (n=1807), major coronary event (n=1190), ischaemic stroke (n=4362) and intracerebral haemorrhage (n=469), respectively. There was an apparent J-shaped association with all-cause mortality (n=4503). In this diabetes population, uncontrolled hypertension accounted for 39% of cardiovascular deaths. Interpretation: Uncontrolled hypertension is common in Chinese adults with T2D, resulting in substantial excess risks of CVD. Improved hypertension management could avoid a large number of cardiovascular-related deaths. Funding: Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF.