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Targeting blood pressure in people with diabetes mellitus

K Scott Brimble

    Polskie Archiwum Medycyny Wewnetrznej
    |July 1, 2016
    PubMed

    Insights

    Treating hypertension in diabetes is crucial for cardiovascular health. Current guidelines vary, with trials like ACCORD and SPRINT offering conflicting evidence on optimal blood pressure targets for individuals with diabetes.

    Area of Science:

    • Cardiology
    • Endocrinology
    • Clinical Trials

    Background:

    • Hypertension is a significant risk factor for cardiovascular morbidity and mortality.
    • The combination of hypertension and diabetes mellitus substantially elevates cardiovascular risk.
    • Optimal blood pressure targets for patients with diabetes remain debated, leading to varied clinical practice guidelines.

    Purpose of the Study:

    • To review the current evidence and guidelines regarding blood pressure targets in patients with diabetes mellitus.
    • To analyze the implications of trials like ACCORD and SPRINT on hypertension management in diabetic populations.
    • To identify the need for further research on optimal blood pressure control in this high-risk group.

    Main Methods:

    • Review of existing clinical practice guidelines and landmark trials (ACCORD, SPRINT).
    • Analysis of meta-analyses examining blood pressure targets in patients with diabetes.
    • Discussion of the methodological limitations of current research.

    Main Results:

    • The ACCORD trial found no benefit in lowering systolic blood pressure (SBP) to <120 mmHg versus <140 mmHg in diabetics.
    • The SPRINT trial showed benefits of SBP <120 mmHg, but excluded patients with diabetes.
    • Meta-analyses suggest targeting SBP 130-140 mmHg for diabetics with baseline SBP >140 mmHg, noting potential risks of lower targets.

    Conclusions:

    • There is a lack of consensus on the optimal blood pressure target for individuals with diabetes.
    • Lowering blood pressure targets may reduce stroke risk but could increase other cardiovascular risks.
    • A large randomized controlled trial is needed to determine the ideal blood pressure targets in people with diabetes mellitus.

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