J Korean Diabetes.  2013 Mar;14(1):1-5.

Target Blood Pressure in Diabetes

• Kim DJ

Abstract

Many epidemiologic analyses and several clinical trials have shown that lowering blood pressure improved clinical outcomes. The benefits of lowering blood pressure were more prominent in cases of diabetes than in non-diabetic patients. Several randomized trials have demonstrated the benefit of lowering diastolic blood pressure to < 80 mm Hg in people with diabetes. However, the evidence for benefits associated with systolic blood pressure of < 130 mm Hg is limited. Recently, the Action to Control Cardiovascular Risk in Diabetes study reported that, in people with type 2 diabetes, targeting a systolic blood pressure (SBP) of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal cardiovascular events. In actuality, a higher incidence of serious adverse events occurred in the group of SBP < 120 mm Hg. With lack of evidence demonstrating any benefit from lowering SBP to < 130 mm Hg, SBP < 130 mm Hg as a general target in the treatment of diabetes seems to be inappropriate. However, considering that several studies have reported a linear relationship between blood pressure and stroke, compared to the J-shaped relationship between blood pressure and cardiovascular disease, blood pressure goals need to be developed based upon the individualized characteristics of each patient.

Keyword

Diabetes mellitus; Hypertension; Blood pressure

MeSH Terms

Blood Pressure
Cardiovascular Diseases
Diabetes Mellitus
Humans
Hypertension
Incidence
Stroke

Reference

1. SHansson L, Zanchetti A, Carruthers SG, Dahlöf B, Elmfeldt D, Julius S, Ménard J, Rahn KH, Wedel H, Westerling S. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998; 351:1755–62.

2. STight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998; 317:703–13.

3. SAdler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman RR. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000; 321:412–9.

4. SEstacio RO, Jeffers BW, Gifford N, Schrier RW. Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care. 2000; 23(Suppl 2):B54–64.

5. STuomilehto J, Rastenyte D, Birkenhäger WH, Thijs L, Antikainen R, Bulpitt CJ, Fletcher AE, Forette F, Goldhaber A, Palatini P, Sarti C, Fagard R. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med. 1999; 340:677–84.

6. SBakris GL, Gaxiola E, Messerli FH, Mancia G, Erdine S, Cooper-DeHoff R, Pepine CJ. INVEST Investigators. Clinical outcomes in the diabetes cohort of the INternational VErapamil SR-Trandolapril study. Hypertension. 2004; 44:637–42.

7. SACCORD Study Group. Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, Simons-Morton DG, Basile JN, Corson MA, Probstfield JL, Katz L, Peterson KA, Friedewald WT, Buse JB, Bigger JT, Gerstein HC, Ismail-Beigi F. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1575–85.

8. SCooper-DeHoff RM, Gong Y, Handberg EM, Bavry AA, Denardo SJ, Bakris GL, Pepine CJ. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA. 2010; 304:61–8.

9. SSleight P, Redon J, Verdecchia P, Mancia G, Gao P, Fagard R, Schumacher H, Weber M, Böhm M, Williams B, Pogue J, Koon T, Yusuf S. ONTARGET investigators. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens. 2009; 27:1360–9.

10. SBangalore S, Kumar S, Lobach I, Messerli FH. Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and bayesian random-effects meta-analyses of randomized trials. Circulation. 2011; 123:2799–810.

11. SReboldi G, Gentile G, Angeli F, Ambrosio G, Mancia G, Verdecchia P. Effects of intensive blood pressure reduction on myocardial infarction and stroke in diabetes: a meta-analysis in 73,913 patients. J Hypertens. 2011; 29:1253–69.

12. SAppel LJ, Wright JT Jr, Greene T, Agodoa LY, Astor BC, Bakris GL, Cleveland WH, Charleston J, Contreras G, Faulkner ML, Gabbai FB, Gassman JJ, Hebert LA, Jamerson KA, Kopple JD, Kusek JW, Lash JP, Lea JP, Lewis JB, Lipkowitz MS, Massry SG, Miller ER, Norris K, Phillips RA, Pogue VA, Randall OS, Rostand SG, Smogorzewski MJ, Toto RD, Wang X. AASK Collaborative Research Group. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010; 363:918–29.