Influence Of Different Blood Pressure Definitions On Diabetic Microvascular Complications

Objective: In 2017,the American College of Cardiology and American Heart Association(ACC/AHA)hypertension guideline was redefined the category of hypertension.Different from the previous guidelines(JNC-7)≥ 140/90 mm Hg,the new guidelines define hypertension as systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥ 80 mm Hg.The new definition reflects that complications can occur at lower blood pressure levels.Meanwhile,the blood pressure reduction target of diabetes mellitus complicated with cardiovascular disease is also blood pressure < 130/80 mm Hg.In recent years,more and more observational studies have found that there is a correlation between blood pressure and diabetic microvascular complications.At present,the blood pressure threshold that diabetic patients must follow in microvascular complications is not clearly defined.Therefore,the purpose of this study is to explore the relationship between blood pressure categories and diabetic microvascular complications in JNC-7 guidelines and 2017 ACC/AHA guidelines,and to compare the effect of different blood pressure grades on diabetic microvascular complications.Methods: The data of this study were collected from 4891 hospitalized diabetic patients from the First Hospital of China Medical University(Liaoning Diabetic Eye Disease Prevention and Treatment Center)from 2013 to 2018.Then 1868 adult patients with type 2 diabetes and1400 patients with diabetic microvascular complications were included in the study.Blood pressure was grouped according to JNC-7 and 2017 ACC/AHA guidelines,including systolic blood pressure,diastolic blood pressure,isolated systolic hypertension,isolated systolic hypertension and systolic diastolic hypertension.The final event of this study was diabetic microangiopathy(including diabetic retinopathy,diabetic nephropathy and diabetic peripheral neuropathy).Patients with type 2 diabetes were divided into two groups: group with microangiopathy and group without microangiopathy.Chi-square test was used to analyze whether there was significant difference in microangiopathy among patients with different blood pressure levels.Univariate and multivariate Logistic regression models were established to explore the relationship between different blood pressure categories and diabetic microvascular complications and the odds ratio(OR)and 95% confidence interval(95%CI)were calculated,and compared the effects of reclassified blood pressure grades in the two guidelines on diabetic microvascular complications.Age,sex,body mass index,smoking,drinking,duration of diabetes,hemoglobin A1 C and low density lipoprotein cholesterol were adjusted by multivariate Logistic regression model.Results: Diabetic microvascular complications,diabetic retinopathy and diabetic nephropathy were significantly correlated with systolic blood pressure,but there was no correlation between diabetic peripheral neuropathy and systolic blood pressure.At the same time,there was a correlation between diabetic nephropathy and diastolic blood pressure,but not with diabetic microvascular complications,diabetic retinopathy and diabetic peripheral neuropathy.According to the blood pressure grading criteria of JNC-7 guidelines,with blood pressure <120/<80 mm Hg as a reference,prehypertension,grade 1 and 2 hypertension and systolic diastolic hypertension increased the risk of diabetic retinopathy.The OR(95%CI)adjusted by multiple factors were 1.49(1.02-2.17),1.76(1.19-2.61),2.38(1.54-3.66)and 1.46(1.15-1.86),respectively;The grade 1 and 2hypertension and isolated systolic hypertension,systolic diastolic hypertension,increased the risk of diabetic nephropathy,and the OR(95%CI)adjusted by multiple factors were 1.75(1.09-2.81),2.62(1.58-4.35),2.25(1.64-3.09)and2.32(1.75-3.09),respectively.According to the blood pressure grading criteria of the 2017 ACC/AHA guidelines,with blood pressure <120/<80mm Hg as a reference,grade 1 and 2 hypertension and isolated systolic hypertension,systolic diastolic hypertension,increased the risk of diabetic retinopathy,the multiple risk adjusted OR(95%CI)were 1.53(1.04-2.24),1.94(1.32-2.83),1.58(1.07-2.32)and 1.59(1.20-2.12),respectively;The grade 2 hypertension,isolated systolic hypertension and systolic diastolic hypertension increased the risk of diabetic nephropathy,and the OR(95%CI)adjusted by multiple factors were 2.00(1.26-3.16),2.37(1.47-3.81)and2.16(1.48-3.15),respectively.In addition,it was not possible to increase the overall blood pressure levels of diabetic microvascular complications and diabetic peripheral neuropathy in both guidelines.Conclusion: In the cross-sectional study of type 2 diabetes,epidemiological evidence showed that there was a correlation between systolic blood pressure and diabetic microangiopathy,but there was no correlation between diastolic blood pressure and diabetic microangiopathy.With the increase of systolic blood pressure,the risk of diabetic nephropathy and diabetic retinopathy is increasing.However,the results of the study found no association between hypertension and diabetic peripheral neuropathy.Different blood pressure levels in the JNC-7 and 2017 ACC/AHA guidelines increased the risk of diabetic retinopathy and diabetic nephropathy.At the same time,there were differences in the effects of reclassified blood pressure grades on diabetic retinopathy and diabetic nephropathy.The above conclusions suggest that strengthening blood pressure control is beneficial to the prevention of microvascular complications in patients with type 2 diabetes mellitus.