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Blood pressure lowering in patients with diabetes--one level might not fit all

Rhonda M Cooper-DeHoff1, Eric F Egelund, Carl J Pepine

  • 1Department of Pharmacotherapy and Translational Research, College of Pharmacy, PO Box 100486, University of Florida, Gainesville, FL 32610-0486, USA. dehoff@cop.ufl.edu

Nature Reviews. Cardiology
|November 17, 2010
PubMed

Insights

Aggressively lowering blood pressure (BP) in patients with both hypertension and diabetes may not always improve outcomes. Personalized treatment based on individual risk is recommended over strict BP targets.

Area of Science:

  • Cardiology
  • Endocrinology
  • Clinical Medicine

Background:

  • Hypertension and diabetes mellitus commonly coexist, increasing patient complications and mortality.
  • Current guidelines recommend aggressive blood pressure (BP) goals for diabetic patients, but supporting data are limited.
  • Lowering BP may not universally benefit all patients with both conditions.

Purpose of the Study:

  • To review evidence on BP treatment in patients with hypertension and diabetes.
  • To evaluate the J-shaped curve relationship between BP and outcomes in diabetic patients.
  • To propose individualized BP treatment recommendations.

Main Methods:

  • Review of randomized clinical trials and observational data on BP management in hypertensive diabetic patients.
  • Analysis of evidence concerning the J-shaped curve in diabetes.
  • Synthesis of data to inform treatment recommendations.

Main Results:

  • Evidence supporting aggressive BP lowering in all diabetic hypertensive patients is lacking.
  • The J-shaped curve suggests that excessively low BP may be associated with adverse outcomes in diabetes.
  • Individualized risk assessment is crucial for optimal BP management.

Conclusions:

  • Current aggressive BP targets for patients with hypertension and diabetes may not be universally beneficial.
  • A personalized approach, considering individual risk factors, is superior to generalized aggressive BP targets.
  • Future treatment strategies should prioritize personalized BP management for better patient outcomes.

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