1421-P: The Impact of Blood Pressure on Risk of Death Is Influenced by Prior Cardiovascular Disease in Patients with Type 2 Diabetes and a Recent Coronary Event
Authors: WIJKMAN MAGNUS O. , CLAGGETT BRIAN , DIAZ RAFAEL , GERSTEIN HERTZEL C. , KOBER LARS , LEWIS ELDRIN , MAGGIONI ALDO P. , WOLSK EMIL , AGUILAR DAVID , BENTLEY-LEWIS RHONDA , MCMURRAY JOHN J. , PROBSTFIELD JEFFREY L. , RIDDLE MATTHEW C. , TARDIF JEAN-CLAUDE , SOLOMON SCOTT , PFEFFER MARC A. 
Published: June 2020

The relationship between blood pressure and mortality in T2DM is controversial, with concern for increased risk associated with lower blood pressure. We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline systolic blood pressure (SBP) and mortality in 5852 patients with T2DM who, as required for entry to the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial, had a recent acute coronary syndrome (ACS). Risk of death was assessed in a Cox model that adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, natriuretic peptide (BNP) and urine albumin/creatinine at baseline. Overall there was no significant association between SBP and risk of death (P=0.20), but in 2325 patients with additional CVD (index ACS + at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure) there was a significant association between lower SBP and higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13; 95% CI 1.05 to 1.23) whereas in 3527 patients with only the index ACS no association was observed (hazard ratio per 10 mmHg lower SBP 0.95; 95% CI 0.86 to 1.04, P for interaction &lt;0.001). In ELIXA participants, an association between lower SBP and higher risk of death was seen only in patients with additional CVD.

Disclosure
M.O. Wijkman: None. B. Claggett: None. R. Diaz: None. H.C. Gerstein: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Consultant; Self; Kowa Pharmaceuticals America, Inc. Research Support; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Sanofi. L. Kober: Speaker’s Bureau; Self; AstraZeneca, Novartis AG. Other Relationship; Self; AstraZeneca. E. Lewis: Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen, Novartis Pharmaceuticals Corporation, Theracos, Inc. A.P. Maggioni: None. E. Wolsk: None. D. Aguilar: None. R. Bentley-Lewis: Consultant; Self; Novo Nordisk Inc. Research Support; Self; Janssen Pharmaceuticals, Inc. J.J. McMurray: Other Relationship; Self; AbbVie Inc., Alnylam Pharmaceuticals, Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Bristol-Myers Squibb, Cardurion, GlaxoSmithKline plc., Novartis Pharmaceuticals Corporation, Theracos, Inc. J.L. Probstfield: None. M.C. Riddle: Consultant; Self; ADOCIA, Dance Biopharm Holdings, Inc., GlaxoSmithKline plc., Sanofi US, Theracos, Inc. Research Support; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk Inc. J. Tardif: Research Support; Self; Esperion Therapeutics, Inc., Ionis Pharmaceuticals, Inc., REGENXBIO Inc., Sanofi, Servier. Other Relationship; Self; Amarin Corporation, AstraZeneca, DalCor Pharmaceuticals. S. Solomon: Consultant; Self; AstraZeneca, Theracos, Inc. Research Support; Self; AstraZeneca, Theracos, Inc. M.A. Pfeffer: Consultant; Self; AstraZeneca, CinCor, Correvio, Corvidia, DalCor Pharmaceuticals, GlaxoSmithKline plc., Innovative Science, Jazz Pharmaceuticals, MyoKardia, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., PharmaScience, Sanofi US, Servier, Takeda Development Center Americas, Inc. Research Support; Self; Novartis Pharmaceuticals Corporation.

Funding
Sanofi (NCT01147250)