{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T02:49:58Z","timestamp":1793069398793,"version":"4.5.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,10,16]]},"abstract":"\n Background<\/jats:title>\n \n Blood pressure (\n BP<\/jats:styled-content>\n ) treatment goals in patients with diabetes mellitus and increased cardiovascular risk remain controversial. Our study objective was to determine cardiovascular outcomes according to achieved\n BP<\/jats:styled-content>\n s over the average follow\u2010up period in the EXAMINE (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care) trial.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n EXAMINE<\/jats:styled-content>\n was a cardiovascular outcomes trial in 5380 patients with type 2 diabetes mellitus and recent acute coronary syndromes. Risks of major adverse cardiac events and cardiovascular death or heart failure were analyzed using a Cox proportional hazards model with adjustment for baseline covariates in 10\u2010mm\u00a0Hg increments of clinician\u2010measured systolic\n BP<\/jats:styled-content>\n from \u2264100 to >160\u00a0mm\u00a0Hg and diastolic\n BP<\/jats:styled-content>\n from \u226460 to >100\u00a0mm\u00a0Hg averaged during the 24\u00a0months after randomization. Based on 2015 guidelines from the American College of Cardiology, the American Heart Association and the American Society of Hypertension and 2017 American Diabetes Association guidelines, systolic\n BP<\/jats:styled-content>\n s of 131 to 140\u00a0mm\u00a0Hg and diastolic\n BP<\/jats:styled-content>\n s of 81 to 90\u00a0mm\u00a0Hg were the reference groups. A U\u2010shaped relationship between cardiovascular outcomes and\n BP<\/jats:styled-content>\n s was observed. Importantly, compared with the systolic\n BP<\/jats:styled-content>\n reference group, adjusted hazard ratios for major adverse cardiac events and cardiovascular death or heart failure were significantly higher in patients with systolic\n BP<\/jats:styled-content>\n s <130\u00a0mm\u00a0Hg. Similarly, compared with the diastolic\n BP<\/jats:styled-content>\n reference group, adjusted hazard ratios for major adverse cardiac events and for cardiovascular death or heart failure were significantly higher for diastolic\n BP<\/jats:styled-content>\n s <80\u00a0mm\u00a0Hg.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In patients with type 2 diabetes mellitus and recent acute coronary syndrome, average\n BP<\/jats:styled-content>\n s <130\/80\u00a0mm\u00a0Hg were associated with worsened cardiovascular outcomes. These data suggest that intensive control of\n BP<\/jats:styled-content>\n in patients with type 2 diabetes mellitus and ischemic heart disease should be evaluated in a prospective randomized trial.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 00968708.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.009114","type":"journal-article","created":{"date-parts":[[2018,10,14]],"date-time":"2018-10-14T09:01:55Z","timestamp":1539507715000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Average Clinician\u2010Measured Blood Pressures and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus and Ischemic Heart Disease in the EXAMINE Trial"],"prefix":"10.1161","volume":"7","author":[{"given":"William B.","family":"White","sequence":"first","affiliation":[{"name":"University of Connecticut School of Medicine Farmington CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Jalil","sequence":"additional","affiliation":[{"name":"University of Connecticut School of Medicine Farmington CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Cushman","sequence":"additional","affiliation":[{"name":"Memphis Veterans Affairs Medical Center University of Tennessee Health Science Center Memphis TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George L.","family":"Bakris","sequence":"additional","affiliation":[{"name":"University of Chicago Medicine Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Bergenstal","sequence":"additional","affiliation":[{"name":"Park Nicolett Clinic St. Louis Park MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon R.","family":"Heller","sequence":"additional","affiliation":[{"name":"University of Sheffield United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyin","family":"Liu","sequence":"additional","affiliation":[{"name":"Baim Clinical Research Institute Boston 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