Aggressive Blood Pressure Control Increases Coronary Heart Disease Risk Among Diabetic Patients

OBJECTIVEdBlood pressure control can reduce the risk of coronary heart disease (CHD) among diabetic patients; however, it is not known whether the lowest risk of CHD is among diabetic patients with the lowest blood pressure level. RESEARCH DESIGN AND METHODSdWe performed a prospective cohort study (2000–2009) on diabetic patients including 17,536 African Americans and 12,618 whites. Cox proportional hazards regression models were used to estimate the association of blood pressure with CHD risk. RESULTSdDuring a mean follow-up of 6.0 years, 7,260 CHD incident cases were identified. The multivariable-adjusted hazard ratios of CHD associated with different levels of systolic/di-astolic blood pressure at baseline (,110/65, 110–119/65–69, 120–129/70–80, and 130–139/ 80–90 mmHg [reference group]; 140–159/90–100; and $160/100 mmHg) were 1.73, 1.16, 1.04, 1.00, 1.06, and 1.11 (P trend,0.001), respectively, for African American diabetic patients, and 1.60, 1.27, 1.08, 1.00, 0.95, and 0.99 (P trend,0.001) for white diabetic patients, respec-tively. A U-shaped association of isolated systolic and diastolic blood pressure at baseline as well as blood pressure during follow-up with CHD risk was observed among both African America