In search for the ‘sweet spot’ for blood pressure level in diabetes

There have been numerous analyses of clinical trials in people with diabetes assessing the effect of blood pressure level on cardiovascular outcomes including hospitalisations. Only two trials, however, have prospectively randomised blood pressure levels in patients with type 2 diabetes to evaluate cardiovascular outcome, The United Kingdom Prospective Diabetes Study (UKPDS)1 and the Action to Control Cardiovascular Risk in Diabetes (ACCORD).2 Unfortunately, only the ACCORD was designed to determine the effect of cardiovascular outcomes to a goal blood pressure of <120/80 mm Hg. While the UKPDS showed a lowered cardiovascular event rate, they attained a lower BP goal of 144/82 mm Hg, the ACCORD failed to show an advantage of lower blood pressure on outcomes. Post hoc analyses of trials that had large subgroups of patients with type 2 diabetes such as the International Verapamil SR—Trandolapril (INVEST)3 and the Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH)4 also failed to demonstrate a cardiovascular outcome benefit at a blood pressure below 130/80 mm Hg. One …