Recent clinical trials have led to revised hypertension guidelines, but the relationship between blood pressure (BP) control and mortality in diabetes patients receiving routine care has not been described in a contemporary national U.S. cohort. We studied 130,192 primary care patients in the Veterans Health Administration with diabetes (ICD-9 codes 250.xx + outpatient diabetes prescription), newly started on a BP medication in 2003-2005, and with a mean systolic BP (SBP) >130 mmHg in the year prior to BP drug initiation. Mean on-treatment outpatient SBP in the 2nd year after BP drug initiation was the primary exposure. All-cause and cardiovascular (CV) mortality through 2014 were the primary outcomes; mean follow-up was 9 years. We estimated associations between SBP and mortality using multivariable Cox proportional hazards regression, adjusting for age, sex, race, comorbidities, HbA1c, number of BP drugs, and CV risk factors. Relative to SBP 121-130 mmHg, all-cause and CV mortality were significantly higher in those with an SBP of 100-120 mmHg or >160 mmHg on treatment. All-cause mortality was lowest in those with an SBP of 131-140 mmHg; CV mortality did not differ significantly between those with an SBP between 121 and 160 mmHg.

Conclusions: There was only minor variation in mortality rates for BPs from 121 to 160 mmHg in patients with diabetes and hypertension in routine clinical care, but mortality was higher in those with treated BP <120 mmHg or >160 mmHg.


S. Raghavan: None. Y. Ho: None. M. Rhee: None. J.L. Vassy: None. D.R. Gagnon: None. K. Cho: None. P.W. Wilson: None. L.S. Phillips: Other Relationship; Self; DIASYST Inc.. Research Support; Self; Amylin Pharmaceuticals, Eli Lilly and Company, Novo Nordisk Inc., Sanofi-Aventis, PhaseBio Pharmaceuticals, Inc., Roche Diabetes Care Health and Digital Solutions, AbbVie Inc., Vascular Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., GlaxoSmithKline plc., Pfizer Inc.. Other Relationship; Self; Novartis Pharmaceuticals Corporation, Merck & Co., Inc..

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