Increased systolic blood pressure (SBP) and diastolic blood pressure (DBP) are associated with greater cardiovascular risks among patients with new-onset coronary artery disease (CAD) or cerebrovascular disease (CVD), regardless of glucose status, according to study results recently published in Diabetes Care.

This study included 593,196 individuals with no prior CVD and 589,501 who had no prior CAD. Participants were identified as having normoglycemia (n=382,332 and n=380,812, respectively), borderline glycemia (n=173,376 and n=172,151, respectively), and diabetes (n=37,488 and n=36,538, respectively).

Data were pooled from a nationwide database of health insurance claims in Japan. Risk for CVD and CAD events was estimated using Cox proportional hazards modeling for 5 different SBP/DBP levels (SBP, ≤119, 120-129, 130-139, 140-149, and ≥150 mmHg; DBP, ≤74, 75-79, 80-84, 85-89, and ≥90 mmHg).

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The overall study population experienced 3207 CVD and 2240 CAD events. The risk for CVD and CAD was increasingly higher in each subsequent quintile compared with SBP ≤119 mmHg (borderline glycemia: quintile 2, 1.46 [95% CI, 1.27-1.68]/2.10 [95% CI, 1.73-2.56] to quintile 5, 4.12 [95% CI, 3.38-5.02]/2.52 [95% CI, 1.95-3.26]; diabetes: quintile 2, 1.72 [95% CI, 1.31-2.26]/1.50 [95% CI, 1.19-1.90] to quintile 5, 3.54 [95% CI, 2.66-4.70]/2.52 [95% CI, 1.95-3.26].

The same pattern was observed among the 4 upper quintiles of DBP compared with the lowest quintile. There was a linear relationship between blood pressure and risk for cardiovascular events in both the general population and the subgroup-stratified population.

Limitations to these findings included lack of data on a number of potential confounders, the inclusion of only baseline values as explanatory variables, potential misclassification bias in the determination of glucose status, and the limited number of older adults enrolled in the study.

The study researchers concluded that “cardiovascular risks gradually increased with increases in both SBP and DBP values regardless of the glucose abnormality.” Further research is needed to examine those with “borderline glycemia and diabetes to confirm findings from the current cohort study and apply them to clinical practice.”


Yamada MH, Fujihara K, Kodama S, et al. Associations of systolic blood pressure and diastolic blood pressure with the incidence of coronary artery disease or cerebrovascular disease according to glucose status . Diabetes Care. 2021;44:1-8. doi:10.2337/dc20-2252