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(Hypertension. 2006;47:168.)
© 2006 American Heart Association, Inc.

Original Articles

Complex Relationship Between Blood Pressure and Mortality in Type 2 Diabetic Patients

A Follow-Up of the Botnia Study

Mats Rönnback; Bo Isomaa; Johan Fagerudd; Carol Forsblom; Per-Henrik Groop; Tiinamaija Tuomi; Leif Groop for the Botnia Study Group

From the Folkhälsan Research Center (M.R., B.I., J.F., C.F., P.-H.G., T.T.), Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland; Malmska Municipal Health Care Center and Hospital (B.I.), Jakobstad, Finland; Department of Medicine (T.T.), Helsinki University Central Hospital and Research Program of Molecular Medicine, University of Helsinki, Helsinki, Finland; Department of Endocrinology (L.G.), Wallenberg Laboratory, University Hospital of MAS, Lund University, Malmö, Sweden; and the Department of Medicine (M.R., J.F., C.F., P.-H.G.), Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland.

Correspondence to Per-Henrik Groop, Folkhälsan Research Center, Biomedicum Helsinki (C318b), PO Box 63, FIN-00014 University of Helsinki, Helsinki, Finland. E-mail per-henrik.groop{at}helsinki.fi

The presence of hypertension aggravates the high cardiovascular risk in type 2 diabetic patients. Pulse pressure is a marker of arterial stiffness and constitutes a risk factor for cardiovascular mortality. This study examines the relationship between different blood pressure indices and mortality in a cohort of type 2 diabetic patients. A total of 1294 type 2 diabetic patients with a median age of 69.1 years participated in the Botnia Study from 1990 to 1997. In 2004, after a median follow-up of 9.5 years, data on mortality was collected from the national population registry and hospital records. Systolic and diastolic blood pressure correlated negatively with mortality after adjustment for other risk factors. The association between low systolic and diastolic blood pressure and mortality was pronounced in patients with previous cardiovascular disease. A U-shaped association between pulse pressure and mortality was observed in elderly patients. These observations could be linked to arterial stiffness and heart failure. Low blood pressure in high-risk patients is likely to be a marker of poor health rather than the cause of mortality. The results suggest that the role of blood pressure as a risk marker in elderly type 2 diabetic patients with cardiovascular disease needs to be reevaluated.

Key Words: diabetes mellitus • blood pressure • cardiovascular diseases • elderly • mortality • risk factors