Blood pressure and cardiovascular disease in Koreans with and without diabetes mellitus

Abstract

Abstract Background We sought to evaluate the association between blood pressure (BP) levels and development of cardiovascular diseases (CVDs) in Korean subjects with and without diabetes mellitus (DM). Methods Using the National Sample Cohort of Korea, we analyzed 272,736 subjects aged 20–80 years without previous CVDs who underwent regular health checks between 2009 and 2010. Subjects on anti-hypertensive medications were excluded. CVD was defined as a composite of cardiovascular death, myocardial infarction, and stroke. Participants were grouped by 10mm Hg intervals of systolic BP (SBP) (<110, 110-119, 120-129, 130-139, 140-149, 150-159, >160mmHg) and by 5mm Hg intervals of diastolic BP (DBP) (<70, 70-74, 75-80, 80-84, 85-90, 90-99, >100mmHg). Results The mean age of the study population was 44.5 ± 12.7 years and 144,179 (52.9%) were men. During the follow-up period (median 10.1 [interquartile range, 9.5–10.5] years), 2,715 subjects had 2,840 CVD events, namely, 952 cardiovascular deaths, 1,171 myocardial infarctions, and 717 strokes. In subjects without DM (n=250,302), compared with SBP <110 mmHg as the reference group, the risk of CVD significantly increased with increasing SBP groups (all p<0.05). On the other hand, in DBP groups analyses, only subjects with DBP >100 mmHg was associated with a significantly higher risk of CVDs compared with DBP <70 mmHg as the reference group. In subjects with DM (n=22,434), there was no increased risk of CVD among subjects with SBP 110-129 mmHg compared with SBP <110 mmHg, but SBP ≥130 mm Hg was associated with a significant increase in the incidence of CVDs. However, in DBP groups analyses, there was no significant association of incidence CVDs across DBP groups compared with DBP <70 mmHg. Conclusions In individuals without DM, those with SBP >110 or DBP >100mmHg have a significantly higher risk of CVD. However, in individuals with DM, those with SBP >130 mmHg was only associated with an increased risk of CVD. These results suggest that hypertension management could vary according to the presence of DM.