BP shows linear relationship with cardiovascular, renal outcomes in T2D

Blood pressure (BP) demonstrates a linear or monotonic association with most cardiovascular and renal outcomes in individuals with type 2 diabetes (T2D), reports a study.

Moreover, low systolic (S)BP does not appear to increase the risk of all-cause mortality compared with higher BP targets, suggesting potential reverse causation and unmeasured confounding in previously reported associations.

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

A total of 113 articles, including 5,875,364 participants with T2D from 89 cohorts, met the eligibility criteria. SBP was found to have a J-shaped association with all-cause mortality. The associations of SBP with cardiovascular events and diastolic BP with all-cause mortality were also J-shaped.

After excluding studies with participants who had a baseline cardiovascular disease or cancer, a significantly lower risk of cardiovascular events and a flattened risk of all-cause mortality were seen with lower SBP levels.

Additionally, “[p]ositive linear or monotonic trends were observed for renal events, estimated glomerular filtration rate decline, and development or progression of albuminuria,” the investigators said.