February 10, 2012Current Vascular Pharmacology
Pros and Cons of Aggressive Blood Pressure Lowering in Patients with Type 2 Diabetes
Key result
Aggressive blood pressure lowering (<130/80 mmHg) in diabetes does not further reduce cardiovascular risk compared to <140/90 mmHg, but may reduce cerebrovascular events and slow kidney disease.
Why the study?
Does aggressive blood pressure lowering (< 130/80 mmHg) reduce cardiovascular and microvascular complications in patients with type 2 diabetes compared to standard targets (< 140/90 mmHg)?
Population
Patients with type 2 diabetes and hypertension
Comparison
Aggressive blood pressure lowering vs Standard blood pressure lowering
Design
Review
Authors
Discussion
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Implication
Does not support aggressive BP targets for CV risk reduction in diabetes; leaves open cerebrovascular and renal benefits for prospective validation.
Structured PICO
Does aggressive blood pressure lowering (< 130/80 mmHg) reduce cardiovascular and microvascular complications in patients with type 2 diabetes compared to standard targets (< 140/90 mmHg)?
P
Population
Patients with type 2 diabetes and hypertension
I
Intervention
Aggressive blood pressure lowering (target < 130/80 mmHg)
C
Comparator
Standard blood pressure lowering (target < 140/90 mmHg)
O
Outcome
Macrovascular and microvascular complications (including cardiovascular risk, cerebrovascular events, and progression of chronic kidney disease)
Aggressive blood pressure lowering (<130/80 mmHg) in type 2 diabetes does not clearly reduce overall cardiovascular risk compared to <140/90 mmHg, but may offer benefits for cerebrovascular and advanced kidney disease outcomes.
Limitations
- Failure of most existing clinical trials to either target or achieve mean systolic BP values below 130 mmHg
- Lack of appropriately powered prospective outcome trials supporting aggressive targets
Cite This Study
Kalaitzidis et al. (2012) conducted a review in Type 2 Diabetes and Hypertension. Aggressive blood pressure lowering (< 130/80 mmHg) vs. Standard blood pressure lowering (< 140/90 mmHg) was evaluated. Aggressive blood pressure lowering (<130/80 mmHg) in diabetes does not further reduce cardiovascular risk compared to <140/90 mmHg, but may reduce cerebrovascular events and slow kidney disease.