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.
J. Guo: None. R.G. Miller: None. T. Costacou: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.
National Institutes of Health