338 TYPE 2 DIABETES MELLITUS AND RESIDUAL CARDIOVASCULAR RISK IN HIGH-RISK HYPERTENSIVE PATIENTS

Abstract

Objective: The CASE-J trial and its extension compared the effects of the angiotensin II receptor blocker candesartan with those of the calcium channel blocker amlodipine on the incidence of cardiovascular (CV) events in high-risk Japanese hypertensive patients. Here, we report a subanalysis of the CASE-J Extension which examined the associations between type 2 diabetes mellitus (DM) and residual cardiovascular risk. Methods: Subjects were 4,703 high-risk hypertensive patients participated in the CASE-J trial and Extension (DM(-): n=2,685, DM(+): n=2,018). The primary CV event was a composite of sudden death, cerebrovascular, cardiac, renal, and vascular events for the mean follow-up period of 4.5 years. Achieved blood pressure (BP) was defined as the last value of BP in patients who did not experience CV events, and the value of BP prior to CV events in those who experienced CV events. Results: The multiple Cox regression analyses revealed that DM was an independent predictor of primary CV, cerebrovascular, cardiac and renal events (hazard ratio=2.59, 1.64, 4.64, and 7.17, respectively). With regard to the association of achieved BP with each event risk, low achieved BP was associated with reduced risk of all events irrespective of existence of DM. However, the risk at the same level of achieved BP was higher in patients with DM than those without DM, especially in terms of cardiac and renal events. Conclusion: Lowering BP leads to the reduction of CV risk irrespective of existence of DM, but the residual risk of hypertensive patients with DM still remains high.