Major adverse cardiovascular events in diabetics: network meta-analysis of clinical trials comparing antihypertensive drugs

Abstract

and structural abnormalities in the Rasmussen Center for Cardiovascular Disease Prevention The 9 non-invasive tests, in addition to BP, include small artery and large artery elasticity, exercise BP response, optic fundus photography, carotid ultrasound, microalbuminuria, ECG, left ventricular ultrasound and NT-ProBNP measurement. A Disease Score (DS) of 0-18 is based on abnormalities in these 9 tests, with DS of 0-2 associated with no future morbid events, DS of 3-5 with morbid events delayed by at least 4 years and DS of 6 experiencing a high morbid event rate beginning immediately. Results: After excluding 632 individuals taking anti-hypertensive drugs 1184 were classified by BP: normal (<120/80 mmHg), n1⁄4403; pre-hypertensive stage I (BP range, 120-129/80-84), n1⁄4476); prehypertensive stage II, (BP range, 130-139/85-89), n1⁄4185); hypertensive (BP 140/ 90), n1⁄4120). Mean Disease Score in these 4 groups were 2.5 2.2, 3.5 2.5, 4.3 2.8 and 5.6 3.3, respectively, thus confirming the population relationship between BP and disease. However, DS of 6 was present in over 10% of the normal group, 22% of prehypertension stage I, 30% of prehypertension stage II and 50% of hypertension. The distribution of BP in each of the Disease Score groups was largely overlapping. Conclusion: BP is not a reliable guide to individual risk for cardiovascular morbid events. Early non-invasive disease assessment provides the opportunity for individualized management of early disease regardless of BP.