Background: The new 2017 ACC/AHA high blood pressure (BP) guidelines lowered the target BP for patients with diabetes mellitus (DM) to 130/80mmHg or less. However, there is a concern that extremely low BP may increase cardiovascular (CV) events in DM patients, especially in DM patients with coronary artery disease (CAD). Coronary revascularization has become prevalent in diabetic CAD patients.
Purpose: We investigated the effects of low SBP and DBP on CV events in diabetic CAD patients after coronary revascularization.
Methods: We examined 2,718 DM patients with stable, chronic CAD registered in the CREDO-Kyoto cohort-1, a prospective multi-center registry, enrolling 9,877 CAD patients who underwent the first CABG or PCI.
Results: CV death was not affected by low SBP, whereas DBP below 70 mmHg slightly but not significantly increase CV death (Figure). Low SBP and DBP did not change the risk of non-fatal myocardial infarction and non-fatal stroke. On multivariate Cox proportional hazard regression analysis, DBP below 70 mmHg was not a significant factor for increasing CV death, while creatinine clearance (hazard ratio [HR] 0.970 [95% confidence interval; 0.961–0.978], p=0.000), statin use (HR 0.428 [0.227–0.844], P=0.014), pulse pressure (HR 1.016 [1.003–1.030], P=0.015), hypertension (HR 2.420 [1.090–5.373], P=0.030), and prior myocardial infarction (HR 1.804 [1.037–3.139], P=0.037) were the independent factors for CV death.
Conclusions: In diabetic CAD patients after coronary revascularization, low BP is not a significant factor for increasing CV events. Along with the management of risk factors and comorbidities, strict BP control targeting less than 130/80 mmHg is important for improving the prognosis of diabetic CAD patients after revascularization.