Blood Pressure Lowering in Type 2 Diabetes Reduces Deaths, CVD Outcomes

Marlene Busko
Patients with type 2 diabetes who lowered their systolic blood pressure (BP) had a significantly decreased risk for death and cardiovascular events, especially stroke, in the largest meta-analysis to examine this relationship to date.
Specifically, a 10-mm-Hg reduction in systolic BP was associated with an 11% to 17% lower relative risk of death, cardiovascular events, heart disease, retinopathy, and albuminuria and a 27% lower relative risk of stroke in this review of 40 trials by Connor A Emdin, HBSc, from the George Institute for Global Health, Oxford University, United Kingdom, and colleagues, published in the February 10 issue of Journal of the American Medical Association.
Moreover, patients with an initial systolic BP of 140 mm Hg or lower had a decreased risk for stroke, retinopathy, and progression to albuminuria, compared with their peers with higher initial BPs. And patients who attained a target of 130 mm Hg or lower had a lower risk for stroke and albuminuria compared with their peers with higher final values.

 Thus, the study highlights the need for individualized treatment. It suggests that although “the recent JNC 8 guidelines relaxed the threshold for initiation of BP-lowering treatment from 130 mm Hg to 140 mm Hg in individuals with diabetes…[for patients] with a history of cerebrovascular disease or individuals with mild nonproliferative diabetic retinopathy…BP-lowering therapy below an initial systolic BP level of 140 mm Hg and treatment to a systolic BP level below 130 mm Hg” may be warranted, according to the researchers.

“It is all about individualizing care for the patient in front of you,” Bryan Williams, MD, from the Institute of Cardiovascular Science, London, United Kingdom, who wrote an editorial that accompanied the article, agreed in an email comment to Medscape Medical News.
“What we know about the pathology of diabetic complications and the results of these data tell us that if, as a diabetic, you can tolerate a lower blood pressure than the current guidelines, such as a pressure below 130/80 mm Hg, then it is almost certainly going to be doing you more good than harm, and this is most likely to be the case for younger patients who will better tolerate lower pressures,” he said…….
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Source: Medscape