Patients with both type 2 diabetes and acute heart failure face a significantly lower risk of death but a higher risk of heart failure-related hospitalisation if they have had high systolic blood pressure on discharge from the hospital compared to those with normal blood pressure.
A first-of-its-kind study led by a researcher from Weill Cornell Medicine - Qatar (WCM-Q) - found that those with a systolic blood pressure above 150 mmHg were 45% less likely to die but 47% more likely to be hospitalised for heart failure during a 12-month follow-up period.
“Current guidelines for patients with type 2 diabetes suggest that systolic blood pressure should be lower than 140 mmHg, and lower than 130 mmHg in some individuals,” said the study’s lead author, Dr Charbel Abi Khalil, assistant professor of medicine and genetic medicine at WCM-Q and cardiology consultant at Hamad Medical Corporation’s heart hospital.
“However, patients with both type 2 diabetes and acute heart failure have a distinct pathophysiology of the heart and may benefit from different guidelines.”
Although the study results show significantly better survival among patients with higher systolic blood pressure, Dr Abi Khalil noted that further studies, such as a randomised controlled trial, would be needed before changing medical guidelines for managing blood pressure for patients with both type 2 diabetes and acute heart failure.
Dr Abi Khalil, along with Dr Jassim al-Suwaidi, Dr Kadhim Sulaiman and other colleagues, analysed health records of 2,492 patients with type 2 diabetes among 5,005 individuals hospitalised with acute heart failure in seven Middle Eastern countries: Oman, Saudi Arabia, Yemen, Kuwait, the UAE, Qatar and Bahrain.
Based on the systolic blood pressure recorded on patients’ hospital discharge papers, they divided patients into four blood pressure levels: below 120 mmHg (low blood pressure), 120-129 mmHG (normal), 130-149 mmHG (moderate) and above 150 mmHG (high).
They then analysed mortality and subsequent heart failure-related hospitalisations over the course of one year following the initial heart failure hospitalisation.
Rates of death and hospitalisation among people with low or moderate systolic blood pressure were not significantly different from the rates observed in those with normal blood pressure.
People with high blood pressure showed a significantly lower rate of death and higher rate of hospitalisations compared to those with normal blood pressure, even after the researchers adjusted the analysis to account for age, gender, smoking, cholesterol, heart rate, creatinine and left ventricle ejection fraction.
The findings echo other studies in which cardiovascular risk factors have been linked with outcomes that seem counterintuitive, Dr Abi Khalil added.