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Pros and cons of aggressive blood pressure lowering in patients with type 2 diabetes

Rigas G Kalaitzidis1, George L Bakris

  • 1Hypertensive Diseases Unit, University of Chicago-Pritzker School of Medicine, Chicago, IL 60637, USA.

Current Vascular Pharmacology
|January 14, 2012
PubMed

Insights

Aggressively lowering blood pressure (BP) in diabetic patients may slow chronic kidney disease progression and reduce cerebrovascular events. However, evidence for further cardiovascular risk reduction below 140/90 mmHg is limited, necessitating careful consideration of BP targets.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Hypertension management in diabetes aims to prevent macrovascular and microvascular complications.
  • Current guidelines often recommend aggressive blood pressure (BP) targets (< 130/80 mmHg) for patients with diabetes.
  • Retrospective data suggest benefits of lower BP for chronic kidney disease (CKD) and cardiovascular (CV) risk, but prospective trial data are limited.

Purpose of the Study:

  • To review and examine the evidence supporting and refuting aggressive BP lowering in patients with diabetes.
  • To address unanswered questions regarding optimal BP targets in this population.
  • To evaluate the impact of aggressive BP lowering on CKD progression and CV risk.

Main Methods:

  • Review of existing clinical trials and retrospective data analyses.
  • Evaluation of randomized trials assessing different BP lowering strategies.
  • Analysis of data specifically related to BP targets below 130/80 mmHg in diabetic patients.

Main Results:

  • Lower BP levels consistently show a benefit in reducing cerebrovascular events.
  • Evidence suggests that lower BP slows the progression of advanced proteinuric kidney disease.
  • Recent randomized trials do not consistently support BP targets below 130/80 mmHg for further CV risk reduction compared to < 140/90 mmHg.

Conclusions:

  • A BP goal of < 130/80 mmHg is defensible for slowing advanced proteinuric kidney disease progression in diabetic patients.
  • The evidence for additional cardiovascular risk reduction with BP < 130/80 mmHg compared to < 140/90 mmHg in diabetes is not robust.
  • Further research is needed to clarify optimal BP targets for comprehensive risk reduction in diabetic patients.

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