Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from...

Area of Science:

• Cardiology
• Endocrinology
• Nephrology

Background:

• Current hypertension guidelines recommend BP goals of <140/90 mm Hg, or <130/80 mm Hg for diabetic patients.
• The ACCORD trial indicated that lower BP targets may not be beneficial in diabetic patients.
• Optimal BP targets for individuals with diabetes or glucose intolerance remain undefined.

Purpose of the Study:

• To evaluate the optimal systolic blood pressure (BP) target for patients with type 2 diabetes mellitus or impaired glucose tolerance.
• To analyze the association between intensive BP control and cardiovascular and microvascular events.

Main Methods:

• A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted.
• Searches included PUBMED, EMBASE, and CENTRAL databases for trials published from 1965 to October 2010.
• Included trials involved at least 100 patients with type 2 diabetes or glucose intolerance, achieved systolic BP ≤135 mm Hg (intensive) vs. ≤140 mm Hg (standard), and a follow-up of at least 1 year.

Main Results:

• 13 RCTs with 37,736 participants were analyzed.
• Intensive BP control showed a 10% reduction in all-cause mortality and a 17% reduction in stroke.
• However, intensive control also led to a 20% increase in serious adverse events, with no significant differences in other macrovascular or microvascular outcomes.

Conclusions:

• A systolic BP treatment goal of 130-135 mm Hg is acceptable for patients with type 2 diabetes or glucose intolerance.
• More aggressive BP goals (<130 mm Hg) further reduced stroke risk but did not benefit other macrovascular/microvascular events and increased serious adverse events.
• Target organ heterogeneity exists, with stroke risk decreasing at lower BP levels, but other risks increasing.