October 1, 2015Open Access
Understanding and treating hypertension in diabetic populations.
Population
Patients with hypertension and diabetes
Design
Review
Authors
Discussion
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Member takes
Implication
Caution advised against SBP <120 mmHg targets in high-risk diabetics; leaves optimal thresholds open for prospective trials.
Key Points
- To review the shared pathophysiology, pharmacological interventions, and evidence-based blood pressure targets in patients with coexisting hypertension and diabetes.
- Narrative synthesis evaluating historical and recent randomized clinical trials testing standard versus intensive blood pressure lowering in individuals with diabetes.
- Analysis of cardiovascular outcomes, specifically macrovascular and microvascular endpoints, across distinct achieved systolic blood pressure thresholds.
- Achieving blood pressure levels below 140/90 mmHg consistently reduces the risk of macrovascular and microvascular complications in hypertensive patients with diabetes.
- Intensive antihypertensive therapy targeting systolic blood pressure below 120 mmHg paradoxically increases the risk of coronary events, primarily myocardial infarction, in high-risk diabetic subsets.
Structured PICO
P
Population
Patients with hypertension and diabetes
I
Intervention
Pharmacological antihypertensive treatment (including intensive therapy targeting systolic BP <120 mmHg)
This review highlights that intensive blood pressure lowering (systolic BP <120 mmHg) in diabetic patients may paradoxically increase coronary event risk, challenging previous guidelines.
Cite This Study
Volpe et al. (2015) studied this question.