Abstract 12200: Blood Pressure Control in Diabetic Patients is Most Effective Between Ages 65 to 75 for Prevention of Atherosclerotic Events

Abstract

Background: In 2013, the blood pressure (BP) control target for diabetic patients was changed in both Europe and USA; however, there was a paucity of supporting evidence. We investigated whether BP control<140/90 mmHg was effective in any age group in diabetic patients for preventing atherosclerotic events. Methods: We performed the Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial to examine the efficacy of low-dose aspirin therapy in 2536 type 2 diabetes patients. After completion of the JPAD trial in 2008, we followed up the same subjects until 2013, the JPAD2 cohort. Primary end points were a composite of ischemic heart disease, stroke, peripheral arterial disease, and sudden death. We divided the patients into either a high age 65 (H65) group (n=1360; age≥65 years) or a low age 65 (L65) group (n=1176; age<65 years). We then re-divided the patients into a high age 75 (H75) group (n=412; age≥75 years) or a low age 75 (L75) group (n=2124; age<75 years). Results: Systolic BP was unchanged 131 mmHg in 2009 and 130 mmHg in 2013 in each JPAD patients. Diastolic BP decreased from 73 mmHg in 2009 to 71 mmHg in 2013. The difference of incidence of atherosclerotic events between BP≥140/90 patients and BP<140/90 patients was significant in H65 group (P=0.0026, Figure). During a median of 8.1 years, the difference of incidence of the events between the patient groups was not significant in the L65 group (P=0.4515, Figure). The difference of incidence of the events was not significant in H75 group (P=0.8050, Figure). The difference of incidence of the events was significant in the L75 group (P=0.0034, Figure). Conclusions: The difference of incidence of atherosclerotic events between BP≥140/90 patients and BP<140/90 patients was significant only when patients aged 65 to 75 years is included in the analysis. This study then supports a recommendation of the guidelines that better BP control target of age≥75 years patients is not necessary to be BP<140/90 mmHg.