The current American, European, and Japanese guidelines for hypertension treatment have lowered blood pressure (BP) targets to <130/80 mmHg in patients with diabetes mellitus (DM) and patients with coronary artery disease (CAD). However, there is concern that low BP may increase cardiovascular events in diabetic CAD patients. Currently, coronary revascularization has become widespread in diabetic CAD patients. Thus, whether low BP is an independent risk factor for cardiovascular events in diabetic CAD patients after revascularization was investigated. We examined 2718 stable CAD patients with DM in the CREDO-Kyoto cohort-1 registry enrolling 9877 patients who underwent their first percutaneous coronary intervention or coronary bypass grafting. There were no cutoff points for systolic BP (SBP) below which the age- and sex-adjusted hazard ratios for cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke increased. The cutoff diastolic BP (DBP) for increasing cardiovascular death was 70 mmHg ( P = 0.014), whereas there was no cutoff DBP for increasing nonfatal MI and nonfatal stroke. However, on stepwise Cox hazard proportional regression analysis, the independent factors increasing cardiovascular death were hypertension, low creatinine clearance, wide pulse pressure, prior MI, and nonuse of statins, but DBP < 70 mmHg was not a significant factor. In conclusion, in diabetic CAD patients after coronary revascularization, low SBP and DBP were not significant factors that increased cardiovascular events. Careful attention should be paid to vascular lesions and organ damage that have already progressed.

中文翻译：

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血运重建后冠状动脉疾病糖尿病患者的低血压和心血管事件：CREDO-Kyoto 注册队列 1

目前美国、欧洲和日本的高血压治疗指南已将糖尿病 (DM) 患者和冠状动脉疾病 (CAD) 患者的血压 (BP) 目标降低至 <130/80 mmHg。然而，有人担心低血压可能会增加糖尿病 CAD 患者的心血管事件。目前，冠状动脉血运重建已在糖尿病 CAD 患者中广泛应用。因此，研究了低血压是否是糖尿病 CAD 患者血运重建后心血管事件的独立危险因素。我们检查了 CREDO-Kyoto cohort-1 注册中的 2718 名患有 DM 的稳定型 CAD 患者，招募了 9877 名接受了首次经皮冠状动脉介入治疗或冠状动脉旁路移植术的患者。收缩压 (SBP) 没有临界点，低于该临界点，心血管死亡、非致命性心肌梗死 (MI) 和非致命性卒中的年龄和性别调整风险比会增加。增加心血管死亡的舒张压临界值 (DBP) 为 70 mmHg (P = 0.014)，而没有增加非致命性 MI 和非致命性卒中的临界舒张压 DBP。然而，在逐步 Cox 风险比例回归分析中，增加心血管死亡的独立因素是高血压、低肌酐清除率、宽脉压、既往 MI 和未使用他汀类药物，但 DBP < 70 mmHg 不是显着因素。总之，在冠状动脉血运重建后的糖尿病 CAD 患者中，低 SBP 和 DBP 不是增加心血管事件的显着因素。