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Evidence-based hypertension treatment in patients with diabetes

Mariana Garcia-Touza1, James R Sowers1

  • 1From the Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, University of Missouri ; 1 the Department of Medical Physiology and Pharmacology ; 2 and the Harry S. Truman VA Medical Center, Columbia, MO 3.

Journal of Clinical Hypertension (Greenwich, Conn.)
|January 27, 2012
PubMed

Insights

Hypertension in diabetes patients requires careful blood pressure management. A goal of 135/85 mmHg may balance reducing stroke and coronary artery disease risks, based on recent trial data.

Area of Science:

  • Cardiology
  • Endocrinology
  • Nephrology

Background:

  • Diabetes and impaired glucose tolerance significantly increase risks for hypertension, cardiovascular disease, and renal disease.
  • Recent clinical trials are evolving hypertension treatment goals for diabetic patients.
  • Previous trials like ACCORD BP and INVEST did not show additional cardiovascular benefits at lower blood pressure targets.

Purpose of the Study:

  • To evaluate the optimal blood pressure goal for patients with diabetes.
  • To analyze the impact of different blood pressure targets on cardiovascular and stroke events in diabetic populations.

Main Methods:

  • Review of recent clinical trials including ACCORD BP and INVEST.
  • Post hoc analysis of patient data from the International Verapamil-Trandolapril Study (INVEST).
  • Examination of evidence regarding blood pressure reduction and its effect on stroke and coronary events.

Main Results:

  • Lowering systolic blood pressure below 130 mmHg reduced stroke events but not coronary disease events in diabetic patients.
  • The Action to Control Cardiovascular Risk in Diabetes-BP Arm (ACCORD BP) trial showed no additional cardiovascular benefit at a mean systolic BP of 119 mmHg.
  • The International Verapamil-Trandolapril Study (INVEST) found no additional cardiovascular risk reduction at BP <130/80 mmHg.

Conclusions:

  • The precise blood pressure goal for diabetic patients remains under investigation.
  • A blood pressure goal of 135/85 mmHg is proposed as a reasonable compromise.
  • This target may offer a balance in reducing composite stroke and coronary artery disease events.

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