LB.01.05] INTENSIVE BLOOD PRESSURE CONTROL AND OUTCOMES IN HYPERTENSIVE PATIENTS WITH DYSGLYCEMIA – STUDY OF GLASGOW BP CLINIC AND SPRINT DATA

Abstract

Objective: We previously showed that hypertensive patients who developed new onset diabetes within 10 years of their first clinic visit (early NOD) had 40% higher mortality than those with with no diabetes or those with late onset. The predictors of early NOD were baseline glucose and BMI. In this study we tested whether intensive blood pressure control could reduce the excess risk of dysglycaemia in patients without type 2 diabetes. Design and method: Data was available for 4743 patients from the GBPC (Glasgow Blood Pressure Clinic) and 8449 participants from the SPRINT trial. Strict BP control in the GBPC was defined as AUC of SBP<140 mmHg in the first year of follow-up (dichotomised). In the SPRINT study, categorisation as intensive and standard BP was derived from the arms as randomised. The outcome was first CV event or death in GBPC and the primary endpoint in SPRINT (composite of MI, ACS, stroke, heart failure, or cardiovascular death). Cox proportional hazards models were adjusted for age, sex, SBP, BMI, smoking status and additionally in SPRINT baseline number of antihypertensive drugs, prevalent CKD, prevalent CVD and trial arm. Results: In GBPC, compared to patients with SBP>140, those with SBP<140 had a higher proportion of females (53.4 vs 47.2%; p < 0.01), were younger (48[14] vs 55[13] years p > 0.01), and had lower baseline glucose (5.5[1.5] vs 5.9[2] mmol/L). Baseline blood glucose>10.9 mmol/L was associated with the primary outcome in the SBP>140 group only. In the SPRINT study, there was no significant baseline demographic difference between randomised groups. There was a clear distinction between the standard and intensive arms with intensive BP control neutralising risk of primary outcomes in the group with glucose >108 mg/dL (6.0 mmol/L). The results are presented in the figure.Conclusions: Intensive blood pressure control appears to reduce the excess cardiovascular risk associated with dysglycaemia. This highlights the close association between blood pressure and glycaemia in the development of CV disease and supports consideration of lower blood pressure targets in patients at risk of diabetes.