With Diabetes, Cutting Blood Pressure a Little May Go a Long Way

Type 2 diabetes patients who reduced their high blood pressure had lower risks of major heart complications

(RxWiki News) Having a normal blood pressure is good for overall health, but in diabetes patients, it may also be critical to preventing major heart problems.

A new study found that reducing blood pressure in diabetes patients may reduce the risk of major heart events and other complications. However, current guidelines for treatment may be too conservative for some patients.

"When it comes to prevention of cardiovascular events, those at highest risk stand to gain the most from medical interventions," said Jeffrey M. Schussler, MD, an interventional cardiologist at Baylor Heart and Vascular Hospital and Baylor University Medical Center at Dallas. "Diabetes, more so than almost any chronic disease, places patients at a high risk of cardiovascular disease.

"This study would suggest that aggressive blood pressure control (more stringent than we're typically advocating) is incrementally beneficial in diabetic patients," Dr. Schussler said.

Connor A. Emdin, HBSc, of the George Institute for Global Health in Oxford, UK, led this study.

"Among patients with type 2 diabetes, [blood pressure] lowering was associated with improved mortality and other clinical outcomes," Emdin and team wrote.

Emdin and team followed more than 100,000 patients with type 2 diabetes from 40 trials completed between 1966 and 2014. All 40 trials involved treatments to reduce blood pressure.

Blood pressure is reported as a ratio of two numbers. The top number, or the systolic blood pressure, records the pressure in the arteries when the heart beats. The bottom number, or the diastolic blood pressure, records the pressure in the arteries when the heart is at rest. Blood pressure is reported in millimeters of mercury (mm Hg). A normal blood pressure is around 120 over 80 mm Hg.

This study found that a reduction of 10 mm Hg in systolic blood pressure was linked to a 13 percent lower risk of death in type 2 diabetes patients.

The same blood pressure reduction was linked to lowered risks of heart disease (11 percent lower), coronary heart disease (12 percent) and stroke (27 percent) in type 2 diabetes patients.

"These findings support the use of medications for [blood pressure] lowering in these patients," Dr. Emdin and team wrote.

However, current guidelines only focus on patients with a systolic blood pressure greater than 140 mm Hg, wrote Bryan Williams, MD, of the National Institute for Health Research in London, in an editorial about this study. The target systolic blood pressure is usually around 130 mm Hg.

"The findings of the study suggest that for some patients, these treatment thresholds and targets might be too conservative, especially for optimally reducing the risk of stroke and the development or progression of albuminuria [a condition tied to diabetes in which patients have too much protein in their urine]," Dr. Williams wrote.

Dr. Williams called for a bolder approach to blood pressure treatment in younger diabetes patients to prevent heart-related problems.

The study and editorial were published online Feb. 10 in JAMA.

Pharmaceutical companies and grants from research institutes funded this research. Some of the study authors received funds from pharmaceutical companies.

Review Date: 
February 9, 2015