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Tag: hypertension

Optimal Blood Pressure Guidelines for CAD Prevention in T1D Patients

Hypertension is a major risk factor for cardiometabolic disease and  is common among the American population with nearly 1 in 3 adults suffering from high blood pressure. The proportion increases in adults with either type 1 or 2 diabetes – 2 out 3 patients report having high blood pressure or taking BP-lowering prescription medications. Current American Heart Association (AHA) guidelines define hypertension stage 1 as a sustained blood pressure reading of over 130/80 mm Hg and over 140/99 mm Hg for stage 2, increasing the number of diagnosed hypertensive patients.

 Blood Pressure Guidelines for Patients with Diabetes 

Despite the updated guidelines, the American Diabetes Association (ADA) currently recommends a blood pressure goal of 140/90 mm Hg for diabetic patients with low heart disease risk and 130/80 mm Hg for individuals at higher risk or those with existing heart disease. As the AHA guidelines advise lower targets – especially for patients with comorbidities – and earlier pharmacologic intervention, the ADA BP goals may prove to be too high for cardiovascular risk prevention. 

According to recent findings presented at the American Diabetes Association Scientific Sessions, patients with youth-onset type 1 diabetes (T1D) may face a significantly greater risk for coronary artery disease at such BP targets. Research from the University of Pittsburgh found that a blood pressure reading of over 120/80 mm Hg combined with HbA1c of more than 8% increased the risk of CAD three-fold in patients with type 1 diabetes developed during childhood compared with those with lower readings. 

 Determining Optimal Blood Pressure Goals for Cardiovascular Health

 Noticing a lack of clinical trial data available to inform blood pressure guidelines in young adults with type 1 diabetes, Dr. Jingchuan Guo and colleagues aimed to determine optimal BP goals for reducing CAD risk in adults with childhood-onset type 1 diabetes. For the analysis, researchers evaluated 605 individuals (mean age:27 years) with youth-onset T1D from the Pittsburgh Epidemiology of Diabetes Complications study. Participants did not have CAD at baseline and were followed for 25 years with biennial surveys and examinations. 

 The associations of time-updated cumulative (mmHg-year) and time-weighted (mmHg) BP measures (systolic and diastolic), and mean artery pressure with the incidence of CAD were analyzed using Cox hazard models. Risk stratification calculations were performed based on time-weighted BP and time-weighted HbA1c. After statistical analysis, researchers determined that the optimal targets for blood pressure for minimizing CAD risk in the cohort was 120/80 mm Hg. Study participants with a higher BP reading were 1.9 times more likely to develop CAD than those with lower measures. 

 Compared with participants who had good BP (<120/80 mm Hg) and HbA1c (<8%), individuals with only high BP measures carried a similar risk to those with only high HbA1C levels. Those who had both a BP over 120/80 mm Hg and HbA1c measure over 8% were 3.1 times more likely to develop coronary artery disease, compared with those who had lower measures of both. 

 Despite the lack of direct randomized trial data, Dr. Guo’s findings support the need for revised blood pressure goals – especially in the case of young adults with type 1 diabetes. The ADA’s current guidelines of 140/90 mm Hg may put such patients at a 3 times greater risk of developing coronary artery disease, while also increasing the risk of other cardiovascular complications. Alongside lowering blood pressure, emphasis should also be placed on maintaining good glycemic control in these individuals. To further reduce these risks, young T1D patients should be closely monitored; their risk factors should be assessed annually and any modifiable abnormal factors should be treated. 

 

The Economic Burden of Cardiovascular Disease

Despite the extensive literature and research that indicates the preventability of cardiovascular disease, it remains a primary and leading cause of not only mortality & morbidity, but also a tremendous health care cost and economic burden. A Vital Signs report recently released by the Centers for Disease Control and Prevention cited that in 2016 alone, myocardial infarction, strokes, heart failure, and other largely preventable cardiovascular conditions caused 2.2 million hospitalizations, 415,000 deaths, and $32.7 billion in costs.

The researchers that conducted the findings estimated that “without preventative interventions, approximately 16.3 million events and $173.7 billion in hospitalization costs could occur during 2017–2021.” Moreover, a second Vital Signs report pulled data from the National Health and Nutrition Examination Survey, the National Survey on Drug Use and Health, and the National Health Interview Survey to assess and analyze the pervasiveness and prevalence of critical, key cardiovascular disease risk factors. Researchers found that 54 million adults are smokers, and could likely benefit from smoking cessation interventions. 71 million adults are not engaging in physical activity, and thus more prone to cardiovascular disease. Furthermore, millions of adults are not taking aspirin as recommended; 39 million adults are not managing their cardiovascular disease risk through suggested statin use; and 40 million adults are living with uncontrolled hypertension.

Quoted in an article published in the American College of Cardiology, Janet S. Wright, MD, FACC—executive director of Million Hearts, a national initiative co-led by the CDC and the Centers for Medicare & Medicaid Services, initially designed as a preventive measure to combat one million heart attacks and strokes by the year 2022—”Small changes–the right changes, sustained over time–can produce huge improvements in cardiovascular health.”
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