Does a “BP Paradox” Exist in Type 2 Diabetes Patients With HF?

Patients with type 2 diabetes and acute heart failure (HF) who also suffer from high systolic blood pressure (BP) may have a significantly lower risk of death but higher risk of heart-failure-related hospitalizations, according to a study presented during ACC.17 in Washington, DC.

Researchers analyzed health records of 2,492 type 2 diabetes patients within the Gulf-CARE Registry, who were hospitalized with acute HF in seven Middle Eastern countries (Oman, Saudi Arabia, Yemen, Kuwait, United Arab Emirates, Qatar and Bahrain). Patients were divided into four BP levels: below 120 mmHg (low BP), 120-129 mmHg (normal BP), 130-149 mmHg (moderate BP) and above 150 mmHg (high BP). They then analyzed mortality and subsequent HF-related hospitalizations during the 12 months following the initial HF hospitalization.

Results showed that patients with systolic BP above 150 mmHg were 45 percent less likely to die but 47 percent more likely to be hospitalized for HF than those within a normal BP range. Results were consistent after researchers adjusted for age, gender, smoking, cholesterol, heart rate, creatinine and left ventricle ejection fraction. Rates of death and hospitalization among patients with low or moderate systolic BP were not significantly different from the rates observed in those with normal BP.

"We could be looking at a 'BP paradox' if our findings are confirmed by future studies," said Charbel Abi Khalil, MD, PhD, lead author of the study. Although the analysis shows association, not cause and effect, he proffered several factors that may help explain the findings. One is that patients with type 2 diabetes, HF and high BP could be more likely to regularly visit cardiologists and diabetes specialists. This regular follow-up could enable more efficient establishment of treatment regimens and earlier diagnosis of other health problems.

"Current guidelines for patients with type 2 diabetes suggest that systolic BP should be lower than 140 mmHg, and lower than 130 mmHg in some individuals," adds Khalil. "However, patients with both type 2 diabetes and acute HF have a distinct pathophysiology of the heart and may benefit from different guidelines." He notes that further studies, such as a randomized controlled trial, would be needed before changing medical guidelines for managing BP for patients with both type 2 diabetes and acute HF.


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