Intense blood pressure lowering benefit confirmed in diabetes

An intensive treatment approach to lower systolic blood pressure to a target of 120 mm Hg in people with Type 2 diabetes has been found to lead to a lower risk of cardiovascular events than a standard treatment.

Previously, blood pressure targets for people with Type 2 diabetes have been unclear. Although the Eighth Joint National Committee recommend a systolic blood pressure of less than 140 mm Hg in people with Type 2 diabetes, most current guidelines recommend a systolic blood pressure of less than 130 mm Hg in people  with diabetes. However, evidence supporting this recommendation has been lacking.

However, the new trial provides “convincing evidence of the benefits of lowering systolic blood pressure to a target of less than 120 mm Hg in people with Type 2 diabetes,” report the investigators. The trial has important implications for blood pressure management in clinical practice and its results “provide support for more intensive systolic blood pressure control in people with diabetes for the prevention of major cardiovascular disease events.”

In the trial, 12,821 people in China aged 50 years and older with Type 2 diabetes were enrolled who had elevated systolic blood pressure and were at an increased risk for cardiovascular disease. They were randomized to receive intensive treatment, with a systolic blood pressure target of less than 120 mm Hg, or standard treatment, with a target of less than 140 mm Hg, for up to 5 years. After 1 year of follow-up, mean systolic blood pressure was lower with intensive than standard treatment (121.6 vs 133.2 mm Hg). Among secondary outcomes, stroke occurred less frequently in the intensive than standard treatment group (1.19 vs 1.50 events per 100 person-years).

“Stroke is the most common type of cardiovascular disease among Chinese persons” the authors report. “These findings provide strong support for a more intensive systolic blood pressure target in people with Type 2 diabetes for the prevention of major cardiovascular events,” study author Guang Ning, MD, PhD, from the Ruijin Hospital at Shanghai Jiao Tong University School of Medicine in Shanghai, China,

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