Impact of Blood Pressure Decrease on Incident HF in Prediabetes, Diabetes Mellitus

nurse measuring blood pressure
A study was conducted to determine the relationship between blood pressure reduction and incident cardiovascular disease in patients with diabetes and hypertension.

The association of blood pressure (BP) reduction with incident heart failure (HF) is attenuated by deteriorating glucose tolerance, as opposed to the association of BP reduction with incident atherosclerotic cardiovascular disease (CVD) not being modified by glycemic status. These findings were published in the American Heart Journal.

A retrospective cohort study was conducted between January 2005 and April 2021, in which data from the JMDC Claims Database (JMDC Inc., Tokyo, Japan), a health checkup and insurance claims database, were used. Researchers sought to identify the clinical effect of a decrease in BP on incident CVD among individuals with both diabetes mellitus (DM) and hypertension. They obtained data on a total of 1,189,289 individuals who had undergone the health checkup bloods tests required by JMDC, including blood tests over 1 year after insurance enrollment.

Patients were classified with stage 1 hypertension (systolic BP [SBP] of 130-139 mm Hg or diastolic BP [DBP] of 80-89 mm Hg) or with stage 2 hypertension (SBP of ≥140 mm Hg or DBP of ≥90 mm Hg), based on the American College of Cardiology/ American Heart Association BP guideline. To be included in the study, patients needed to have BP data available 1 year following insurance enrollment.

Following exclusions, a total of 754,677 participants with stage 1 or stage 2 hypertension were analyzed in the study. Overall, 75.8% of the participants were men. The median patient age was 47 years. All of the participants were classified using plasma fasting glucose (FPG) levels at baseline as normal (FPG <100 mg/dL; n=517,372), prediabetes (FPG 100-125 mg/dL; n=197,836), or DM (FPG ≥126 mg/dL; n=39,469).

The primary study outcome was HF. The secondary outcome was ischemic heart disease (IHD), which included myocardial infarction, angina pectoris, and stroke.

Results of the study revealed that at a mean follow-up of 1111±909 days, a total of 18,429 HF incidents, 17,058 IHD reports, and 8795 occurrences of stroke were recorded. Reduction in BP of less than 120/80 mm Hg at 1 year was associated with a decreased risk for development of HF (hazard ratio [HR], 0.77; 95% CI, 0.72-0.82), IHD (HR, 0.84; 95% CI, 0.79-0.89), and stroke (HR, 0.75; 95% CI, 0.69-0.82) among participants with normal FPG levels. However, it was not associated with a risk for development of HF (HR, 0.98; 95% CI, 0.81-1.17) and stroke (HR, 0.82; 95% CI, 0.62-1.09) among those with DM.

Per interaction analyses, the effect of BP reduction on incident HF was mitigated in individuals with prediabetes or DM. A variety of sensitivity analyses were performed that confirmed these results.

There are several limitations in the study, including the BP and FPG values are from a single health checkup and may not accurately reflect an individual’s BP or FPG phenotype. Further, because of the observational design of the study, the investigators are unable to render any conclusions regarding possible causal association.

“The optimal management strategy for hypertensive people with prediabetes or DM for the prevention of developing CVD (particularly HF) needs to be established,” the researchers wrote.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Suzuki Y, Kaneko H, Yano Y, et al. Glycemic status and the association of change in blood pressure with incident cardiovascular disease. Am Heart J. Published online July 22, 2022. doi:10.1016/j.ahj.2022.07.005