Low SBP does not raise risk of all-cause mortality, CV events

Blood pressure (BP) shows a linear association with several cardiovascular (CV) and renal outcomes in patients with type 2 diabetes (T2D), reveals a study.

A team of investigators performed a systematic search of PubMed, Embase, and Web of Science from inception to 30 November 2024 for cohort studies that examined the associations of BP with all-cause mortality, CV, and renal outcomes. They also assessed curvilinear associations through a one-stage mixed-effects dose-response meta-analysis.

One hundred thirteen articles were identified, including a total of 5,875,364 participants with T2D from 89 cohorts. Systolic BP (SBP) showed J-shaped associations with all-cause mortality and CV events, as did diastolic BP with all-cause mortality, with “flattened risks” at lower BP levels.

Following the exclusion of studies with participants who had CV diseases or cancer at baseline, the investigators observed a significantly reduced risk of CV events and a flattened risk of all-cause mortality among those with lower SBP levels.

Additionally, BP levels displayed positive linear or monotonic trends for renal events, estimated glomerular filtration rate decline, and development or progression of albuminuria.

“Low SBP does not appear to be associated with an elevated risk of all-cause mortality compared with higher BP targets, suggesting that previously reported associations are likely due to reverse causation and unmeasured confounding,” the investigators said.