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Current status of aggressive blood glucose and blood pressure control in diabetic hypertensive subjects

Steven G Chrysant1, George S Chrysant

  • 1Oklahoma Cardiovascular and Hypertension Center and the University of Oklahoma, Oklahoma City, Oklahoma, USA. schrysant@yahoo.com

The American Journal of Cardiology
|April 13, 2011
PubMed

Insights

Aggressively controlling blood glucose and blood pressure in diabetic patients may not offer additional benefits and could be harmful. Current evidence suggests a less aggressive approach to managing these conditions is advisable.

Area of Science:

  • Endocrinology
  • Cardiology
  • Nephrology

Background:

  • Uncontrolled diabetes mellitus (DM) significantly increases cardiovascular risks.
  • Hypertension exacerbates diabetic complications.
  • Previous guidelines recommended aggressive control of blood glucose and blood pressure (BP).

Purpose of the Study:

  • To review recent clinical outcomes trials on aggressive glucose and BP control in patients with DM and hypertension.
  • To evaluate the current scientific consensus on target BP levels for diabetic patients at high cardiovascular risk.

Main Methods:

  • Medline search of English-language papers published between 1998 and 2010.
  • Selection of 15 pertinent reports on aggressive blood glucose and BP control in patients with DM and hypertension.

Main Results:

  • Recent trials indicate that lowering glycosylated hemoglobin to <7.0% and BP to <130/80 mm Hg offers no additional benefit for patients with DM and hypertension.
  • These aggressive targets may potentially be detrimental to patient health.
  • Current scientific opinion suggests a BP target of 130-139/70-80 mm Hg for diabetic patients with increased cardiovascular risk.

Conclusions:

  • The "lower the better" approach for glucose and BP control in diabetic patients is not currently defensible.
  • Less aggressive management strategies for glucose and BP are suggested pending new data.
  • Further research is needed to establish optimal glycemic and BP targets for diabetic patients.

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