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Intensive blood pressure lowering may similarly decrease cardiovascular events in both patients with and patients without type 2 diabetes mellitus, according to a study published online Dec. 6 in Diabetes Care. Tom F. Brouwer, M.D., from the University of Amsterdam, and colleagues assessed the effect of both type 2 diabetes and baseline cardiovascular disease risk on the treatment effect of intensive blood pressure lowering based on data and pooled analysis from two randomized trials (ACCORD-BP [Action to Control Cardiovascular Risk in Diabetes Blood Pressure]and SPRINT [Systolic Blood Pressure Intervention Trial] studies; total of 14,094 patients). The researchers found that the mean baseline systolic blood pressure was 139.5 mm Hg for the cohort and just over one-third (33.6 percent) had type 2 diabetes. The hazard ratio for the primary composite end point of unstable angina, myocardial infarction, acute heart failure, stroke, and cardiovascular death was 0.82 (P = 0.0017). There was a nonsignificant interaction between intensive blood pressure lowering and type 2 diabetes (P = 0.13). While the 10-year cardiovascular risk was higher in patients with type 2 diabetes, there was no interaction between the risk and treatment effect (P = 0.84).

For patients undergoing right heart catheterization (RHC), borderline pulmonary hypertension (PH) is associated with increased risk of mortality, according to a study published online Oct. 25 in JAMA Cardiology. Tufik R. Assad, M.D., from Vanderbilt University School of Medicine in Nashville, Tennessee, and colleagues conducted a retrospective cohort study involving patients undergoing routine RHC for clinical indication. Patients were classified according to mean pulmonary arterial pressure (mPAP) values as reference, borderline PH, and PH (mPAP values of ≤18, 19 to 24, and ≥25 mmHg, respectively). The researchers found that the prevalence of PH and borderline PH was 62 and 18 percent, respectively, among 4,343 patients. Independent associations were seen for advanced age, features of the metabolic syndrome, and chronic heart and lung disease with increased likelihood of borderline PH versus reference patients. Borderline PH was correlated with increased mortality compared with reference patients after adjustment for 34 variables (hazard ratio, 1.31). With higher mPAP there was an incremental increase in the risk of death, without an observed threshold. Sixty-one percent of the 70 patients with borderline PH who underwent repeated RHC had developed overt PH, with a 5 mmHg median increase in mPAP (interquartile range, -1 to 11 mmHg; P < 0.001).