High Blood Pressure and Elevated Glucose Levels Present Comparable Risk for Young Adults with Type 1 Diabetes to Develop Heart Disease

Study of more than 600 people over 25 years indicates lower blood pressure goals beneficial

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Jun 08, 2019, 13:00 ET

SAN FRANCISCO, June 8, 2019 /PRNewswire/ -- High blood pressure and high glucose levels present a similar threat in young adults with type 1 diabetes (T1D) for developing heart disease, with the risk of heart disease doubling with blood pressure levels greater or equal to 120/80 mmHg, according to the study, "Optimal Blood Pressure Goals for Cardiovascular Health in Individuals with Type 1 Diabetes," presented today at the American Diabetes Association's^® (ADA's) 79th Scientific Sessions^® at the Moscone Convention Center in San Francisco.

The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study enrolled patients with T1D who were diagnosed at the age of 17 or younger and seen within one-year of diagnosis at the Children's Hospital of Pittsburgh between 1950 and 1980. This analysis followed 605 of the EDC participants without known baseline coronary artery disease (CAD) for 25 years and aimed to determine optimal blood pressure (BP) goals for minimizing CAD risk.

The novel aspect of this study was that time-weighted blood pressure measurements were created to comprehensively reflect long term exposure to blood pressure. A dose-gradient association was observed between time-weighted systolic and diastolic blood pressure levels (SBP and DBP), along with mean arterial pressure (MAP), and CAD risk, and the study found that the optimal (in terms of lower CAD risk) levels for SBP, DBP and MAP were approximately 120, 80 and 90 mmHg, respectively.

Participants with blood pressure levels ≥120/80 mmHg, compared to <120/80 mmHg, had a twofold increased risk of developing CAD. When participants were stratified into four categories by time-weighted blood pressure (< or ≥ 120/80 mmHg) and time-weighted HbA1c (< or ≥ 8%), compared to participants meeting targets for both blood pressure (<120/80 mmHg) and HbA1c (<8%), the high blood pressure only group carried a similar risk (HR: 2.0 [1.1, 3.9]) as compared to the high HbA1c only group (HR: 1.6 [0.97, 2.8]).These findings support that the optimal blood pressure goals for cardiovascular risk reduction among young adults with T1D lower than the current recommendations of 140/90 mmHg may be beneficial. Lowering blood pressure and meeting glycemic targets both may further reduce cardiovascular risk in these individuals, thus improving long term outcomes and reducing additional serious complications of T1D.

"Our researchers were intrigued by the findings suggesting that blood pressure and glycemia are similarly important for cardiovascular risk prediction in this type 1 diabetes patient group," said lead study author Jingchuan Guo, MD, PhD, postdoctoral fellow at the Center for Pharmaceutical Policy and Policy (CP3) at the University of Pittsburgh. "Since blood pressure control is likely to be as important as glucose control for cardiovascular risk prevention in people with type 1 diabetes, the initial treatment focus should be on glucose control, when HbA1c is very high, but as HbA1c approaches the high-normal range, an increasing focus on blood pressure becomes critical."

To speak with Dr. Guo, please contact the ADA Press Office on-site at the Moscone Convention Center on June 7-11, by phone at 415-978-3606 or by email at [email protected].

The American Diabetes Association's 79th Scientific Sessions, the world's largest scientific meeting focused on diabetes research, prevention and care, will be held June 7-11, 2019, at the Moscone Center in San Francisco, California. Nearly 15,000 leading physicians, scientists, health care professionals and industry representatives from around the world are expected to convene at the Scientific Sessions to unveil cutting-edge research, treatment recommendations and advances toward a cure for diabetes. During the five-day meeting, attendees will receive exclusive access to more than 850 presentations and 2,000 original research presentations, participate in provocative and engaging exchanges with leading diabetes experts, and can earn Continuing Medical Education (CME) or Continuing Education (CE) credits for educational sessions. The program is grouped into eight thematic areas: Acute and Chronic Complications; Behavioral Medicine, Clinical Nutrition, Education and Exercise; Clinical Diabetes/Therapeutics; Epidemiology/Genetics; Immunology/Transplantation; Insulin Action/Molecular Metabolism; Integrated Physiology/Obesity; and Islet Biology/Insulin Secretion. Gretchen Youssef, MS, RDN, CDE, President of Health Care and Education, will deliver her address, "It's All About Access!," on Saturday, June 8, and Louis H. Philipson, MD, PhD, FACP, President of Medicine and Science, will deliver his lecture, "Precision Medicine—Addressing the Many Faces of Diabetes," on Sunday, June 9. Join the Scientific Sessions conversation on social media using #ADA2019.

About the American Diabetes Association
Every day more than 4,000 people are newly diagnosed with diabetes in America. Nearly 115 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the nation's leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For nearly 80 years the ADA has been driving discovery and research to treat, manage and prevent diabetes, while working relentlessly for a cure. We help people with diabetes thrive by fighting for their rights and developing programs, advocacy and education designed to improve their quality of life. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Information is available in English and Spanish. Join the fight with us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).

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Optimal Blood Pressure Goals for Cardiovascular Health in Individuals with
Type 1 Diabetes

News Briefing: Evolving Concepts in Type 1 Diabetes, Sunday, June 9, 12:00 p.m., PT

Session Type: General Poster Session
Location: Poster Hall (Hall F, North, Exhibition Level)
Session Time: Saturday, June 8, 2019, 11:30 a.m. - 12:30 p.m.

JINGCHUAN GUO, RACHEL G. MILLER, TINA COSTACOU, TREVOR J. ORCHARD, Pittsburgh, PA

The study was aimed to determine optimal blood pressure (BP) goals for minimizing coronary artery disease (CAD) risk in adults with childhood-onset type 1 diabetes (T1D). The Pittsburgh Epidemiology of Diabetes Complications study participants without known baseline CAD (n=605) were recruited and then followed for 25 years. The associations of time-updated cumulative (mmHg-year) and time-weighted (mmHg) BP measures (systolic [SBP], diastolic [DBP], and mean artery pressure [MAP]) with incident CAD were examined using Cox proportional hazard models. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) were summarized by different cut-points of time-weighted BPs. Risk stratification analyses were then undertaken based on time-weighted BP (< vs. ≥ 120/80 mmHg) and time-weighted HbA1c (< vs. ≥ 8%). All time-updated cumulative BP measures independently predicted incident CAD over the follow-up period. A dose-gradient association was observed for categorized time-weighted SBP, DBP and MAP in their association with CAD risk. According to both Cox models and AUCs, the optimal cut-points for SBP, DBP and MAP were approximately 120, 80 and 90 mmHg, respectively. Participants with a BP ≥120/80 mmHg, compared to <120/80 mmHg, were associated with 1.9 (95% CI: 1.4, 2.6) times greater risk of developing CAD. Compared to participants with good control of both BP (<120/80 mmHg) and HbA1c (<8%), the high BP only group (HR: 2.0 [1.1, 3.9]) carried a similar risk as compared to high HbA1c only group (HR: 1.6 [0.97, 2.8]). These findings support that lower BP goals (i.e., 120/80 mmHg) than 2018 ADA recommendations (140/90 mmHg) may be needed for young adults with T1D. Lowering BP may further reduce cardiovascular risk in addition to maintaining good glycemic control in these individuals.

Author Disclosure Block: J.Guo: None. R.G.Miller: None. T.Costacou: None. T.J.Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.