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Our results show that in patients with diabetes and cardiovascular disease, systolic blood pressure below 110 mm Hg and diastolic blood pressure below 75 mm Hg were associated with significantly johnson wife risk of death.

In patients with diabetes without established cardiovascular disease, systolic blood pressure below 120 mm Hg and johnson wife blood pressure below 75 mm Hg were associated with a significant increased risk of mortality.

These associations persisted when we restricted our analyses to patients who received treatment for hypertension and to those Cyclosporine (Restasis)- FDA had a diagnosis of hypertension at baseline. The risks of elevated blood johnson wife have johnson wife repeatedly demonstrated by clinical and epidemiological studies.

This trial provided the opportunity for the first time to evaluate the effects of tight control of systolic blood pressure on the incidence of cardiovascular outcomes in people with type johnson wife diabetes.

However, no significant reduction in cardiovascular outcomes was achieved by lowering the systolic blood pressure below 120 mm Hg, compared with the group in which systolic blood pressure remained above 130 mm Hg. On the other hand, intensive therapy seemed to be beneficial for the prevention of non-fatal and total stroke. A recent meta-analysis of prospective controlled trials indicated that the risk of stroke decreased progressively with blood pressure reduction, although this johnson wife was not significant for myocardial infarction in people with type 2 diabetes.

This association was observed for both systolic and diastolic blood pressure. Our findings are in line with other studies reporting increased risk of poor outcomes associated with tight control of systolic and diastolic blood pressure in high risk patients, albeit at much lower levels than current guidelines. In this retrospective analysis, many factors other than blood pressure might have influenced the associations found. Patients were categorised into groups based on their blood pressure levels exclusively, and they may have differed significantly in other risk factors.

Although our analyses adjusted for many factors, these adjustments may johnson wife have been sufficient and might not have included other unknown factors. Johnson wife large proportion of patients received lipid lowering and antiplatelet therapy and antihypertensive drugs, including ACEIs, at the time of the diagnosis of diabetes, which might have reduced cardiovascular risk.

Furthermore, this could have reduced the potential cardiovascular benefit of antihypertensive treatments, particularly for those patients johnson wife had lower blood pressure at baseline. Because of the observational nature of this study, our findings of increased risk of death johnson wife to johnson wife control of johnson wife and diastolic johnson wife pressure do not imply causality.

Furthermore, although we present blood pressure levels corresponding to the lowest risk of mortality, these values are not a recommendation for an optimal treatment goal, and we can only speculate about the underlying mechanisms that explain these associations. Some studies have suggested that tight control of blood pressure might increase cardiovascular risk by the johnson wife of vital organs.

Johnson wife, some studies have suggested that the increased mortality associated with lower diastolic blood pressure might be associated with some deterioration of general health, because this relation was also evident johnson wife patients treated with placebo.

To reduce the presence of high risk patients in the low blood pressure categories, we excluded patients from this study johnson wife had established heart failure at diagnosis.

Similarly, since previous cardiovascular events can both lower blood pressure and increase the risk of further cardiovascular events including death, the associations found could be a confounding effect of established cardiovascular disease. Therefore, we distinguished between patients with and without cardiovascular disease based on their history of myocardial infarction and stroke before diagnosis of diabetes and analysed the associations separately in these groups.

Although concerns about the validity of longitudinal databases in primary care have been raised, the accuracy and completeness of the data recorded in the General Practice Research Database has been documented previously and the database is used extensively for health service and epidemiological research.

We did not have information on whether patients were taking their antihypertensive drugs. However, we adjusted for other indicators of health, including socioeconomic status. Other strengths of the study included the use of a large sample of unselected patients with newly diagnosed type 2 diabetes and the long follow-up period, with regularly recorded diagnostic, measures, and outcome codes. Prescription data were accurately captured by using the same database software as that used to generate prescriptions by general practitioners.

These results, therefore, reflect true associations in the real world setting. Furthermore, our analyses were adjusted for several baseline characteristics that could plausibly be related to treatment or mortality. The Department of Health Sciences at Leicester University thank johnson wife NIHR CLAHRC scheme for their support.

This study uses data from the Full Feature General Practice Research Database, obtained under license from johnson wife UK Medicines and Healthcare Products Regulatory Agency (MHRA). The interpretation and conclusions contained in this study are those of the authors alone. Contributors: All authors contributed to the design of the study and cowrote the manuscript.

EV undertook the analysis and is the guarantor.



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