Lowering blood sugar and BP reduces CVD risk in young diabetics

Lowering blood sugar and BP reduces CVD risk in young diabetics, finds a new study.

In young adults with type 1 diabetes (T1D), high blood sugar levels and high blood pressure (BP) pose a similar cardiovascular threat.

Findings of the study, published in the ADA journal Diabetes, support that lower BP goals (i.e., 120/80 mmHg) than 2018 ADA recommendations (140/90 mmHg) may be needed for young adults with T1D. In addition to maintaining good blood sugar control, lowering the BP may also further reduce cardiovascular risk in these individuals.

The findings were also presented at the 79^th Scientific Sessions of the American Diabetes Association, held from June 7 – 11, 2019.

Jingchuan Guo, MD, PhD, of the University of Pittsburgh, Pennsylvania, and colleagues conducted the study to determine optimal BP goals for minimizing the risk of coronary artery disease (CAD) in adults with childhood-onset type 1 diabetes.

When HbA1c levels are very high, the primary treatment focus in patients with type 1 diabetes should be on blood sugar control, according to Dr Guo. However, when HbA1c levels are within the normal range, the focus on blood pressure becomes increasingly critical.

For the study, the researchers recruited a total of 605 participants without known baseline coronary artery disease and followed them for 25 years. Enrolled patients had been diagnosed with type 1 diabetes at age 17 years or younger.

The novel aspect of the study was that time-weighted blood pressure measurements were created to reflect long-term exposure to blood pressure comprehensively. A dose-gradient association was observed between time-weighted systolic and diastolic blood pressure levels, along with mean arterial pressure, and risk of coronary artery disease.

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Key findings of the study include:

• Optimal (in terms of lower risk of coronary artery disease) levels for systolic blood pressure, diastolic blood pressure, and mean arterial pressure were approximately 120, 80, and 90 mm Hg, respectively.


• Participants with blood pressure levels ≥120/80 mm Hg, vs <120/80 mm Hg, were at a twofold increased risk of developing coronary artery disease.


• When participants were stratified into four categories by time-weighted blood pressure (lower than 120/80 mm Hg or greater) and time-weighted HbA1c (lower than 8% or greater) vs participants who met targets for both blood pressure (<120/80 mm Hg) and HbA1c (<8%), the high blood pressure-only group were at similar risk vs the high HbA1c-only group.

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Dr Guo concluded that the findings supported the possible benefit of optimal blood pressure goals lower than the current recommendations of 140/90 mmHg to reduce cardiovascular risk among young adults with type 1 diabetes.

Lowering blood pressure and blood sugar and meeting glycemic targets may further reduce cardiovascular risk in these individuals, improving long-term outcomes and reducing additional serious complications of type 1 diabetes.

For detailed study log on to https://doi.org/10.2337/db19-1464-P