What is the proper blood pressure target in diabetics?

January 01, 0001

What is the proper blood pressure target in diabetics?

Recent data from the ACCORD trial has questioned the benefit of intensive blood pressure control in diabetics. These US researchers performed a systematic review and meta-analysis of randomized controlled trials of intensive vs standard blood pressure control in patients with diabetes or impaired fasting glucose. They identified 13 suitable studies that included 37 736 enrollees.

The researchers found: "Intensive BP control was associated with a 10% reduction in all-cause mortality (odds ratio, 0.90), a 17% reduction in stroke, and a 20% increase in serious adverse effects, but with similar outcomes for other macrovascular and microvascular (cardiac, renal, and retinal) events compared with standard BP control. The results were similar in a sensitivity analysis using a bayesian random-effects model. More intensive BP control (130 mm Hg) was associated with a greater reduction in stroke, but did not reduce other events. Meta-regression analysis showed continued risk reduction for stroke to a systolic BP of <120 mm Hg. However, at levels <130 mm Hg, there was a 40% increase in serious adverse events with no benefit for other outcomes."

The researchers concluded: "The present body of evidence suggests that in patients with type 2 diabetes mellitus/impaired fasting glucose/impaired glucose tolerance, a systolic BP treatment goal of 130 to 135 mm Hg is acceptable. However, with more aggressive goals (<130 mm Hg), we observed target organ heterogeneity in that the risk of stroke continued to fall, but there was no benefit regarding the risk of other macrovascular or microvascular (cardiac, renal and retinal) events, and the risk of serious adverse events even increased."

This meta-analysis raises questions as to the benefits of intensive blood pressure control in diabetic patients

For the full abstract, click here.

Circulation 123(24):2799-2810, 21 June 2011 © 2011 American Heart Association, Inc.
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. Sripal Bangalore, Sunil Kumar, Iryna Lobach, Franz H. Messerli. Correspondence to Sripal Bangalore: [email protected]

Category: K. Circulatory, T. Endocrine/Metabolic/Nutritional. Keywords: blood pressure, hypertension, diabetes, intensive control, stroke, systematic review and meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 30 September 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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