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Should we change the target blood pressure in diabetic patients?

Gadi Shlomai1, Ehud Grossman

  • 1The Chaim Sheba Medical Center, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.

Diabetes/Metabolism Research and Reviews
|January 3, 2013
PubMed

Insights

Lowering blood pressure (BP) in diabetic patients to near 130/80 mmHg offers stroke protection but may increase adverse effects. Balancing these factors is key for optimal cardiovascular risk management in diabetes.

Area of Science:

  • Cardiology
  • Endocrinology
  • Nephrology

Background:

  • Hypertension is a critical risk factor for cardiovascular disease in diabetic individuals.
  • Current guidelines suggest a blood pressure (BP) target below 130/80 mmHg for patients with diabetes.
  • Previous studies supporting intensive BP control achieved levels higher than the recommended target.

Purpose of the Study:

  • To re-evaluate the benefits and risks of intensive blood pressure control in diabetic patients.
  • To determine the optimal BP target for diabetic patients considering cardiovascular outcomes and adverse effects.
  • To analyze the impact of intensive BP control on mortality, stroke, and other micro/macrovascular complications.

Main Methods:

  • Review and re-analysis of earlier studies on BP control in diabetes.
  • Examination of recently accumulated data regarding intensive BP management.
  • Comparative analysis of outcomes associated with different BP control levels.

Main Results:

  • Intensive BP control significantly reduces all-cause mortality and stroke rates.
  • No significant benefits were observed for other microvascular or macrovascular outcomes (cardiac, renal, retinal).
  • Lowering BP to less than 130/80 mmHg is linked to an increased risk of serious adverse events.

Conclusions:

  • The optimal BP target in diabetic patients requires balancing cerebrovascular protection against increased risks of adverse effects.
  • Intensive BP control may not benefit all microvascular or macrovascular outcomes in diabetes.
  • A BP target close to 130/80 mmHg appears to be a reasonable goal for managing hypertension in diabetic patients.

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