Key result
Initiating BP lowering at systolic 130-140 mmHg in diabetics fails to reduce major cardiovascular events.
Why the study?
The efficacy and safety of initiating blood pressure lowering at baseline systolic blood pressure of 130-140 mm Hg in patients with diabetes remain controversial.
Does initiating blood pressure lowering therapy reduce major cardiovascular events in patients with diabetes and baseline SBP between 130 and 140 mm Hg?
Meta-Analysis (n=21,574)
Does initiating blood pressure lowering therapy reduce major cardiovascular events in patients with diabetes and baseline SBP between 130 and 140 mm Hg?
Relative Risk: 1.01 (95% CI 0.93–1.1)
Initiating blood pressure lowering therapy in diabetic patients with a baseline SBP of 130-140 mm Hg does not reduce cardiovascular events and may increase the risk of serious adverse events and hypotension.
BP lowering initiated at 130-140 mm Hg SBP yields no MACE benefit and may increase harms in diabetes; challenges lower-threshold recommendations and supports 140 mm Hg as initiation cutoff.
The efficacy and safety of blood pressure (BP) lowering initiated at baseline systolic BP (SBP) of 130-140 mm Hg in patients with diabetes remain controversial. The authors aimed to investigate the benefits and harms of BP lowering initiated at these levels for patients with diabetes. Medline and EMBASE were searched from inception to March 10, 2018. The primary outcome was major cardiovascular events. Random-effects model was used to pool all the estimates. Six trials with 21 574 diabetics were included. In diabetics, initiating BP lowering at baseline SBP of 130 and 140 mm Hg did not reduce the rate of major cardiovascular events (RR, 1.01 [95% CI, 0.93-1.10]), finding that was consistent in subgroup and sensitivity analyses. Moreover, BP lowering did not reduce the risks of myocardial infarction (RR, 0.99 [95% CI, 0.85-1.16]), stroke (0.83 [95% CI, 0.54-1.27]), heart failure (0.91 [95% CI, 0.79-1.04]), albuminuria (0.93 [95% CI, 0.84-1.04]), end-stage renal disease (0.93 [95% CI, 0.70-1.24]), cardiovascular death (1.25 [95% CI, 0.90-1.74]) and all-cause death (1.05 [95% CI, 0.94-1.17]) in patients with diabetes and baseline SBP of 130-140 mm Hg but possibly increase the risks of serious adverse events (RR, 2.00 [95% CI, 1.33-3.01]) and hypotension (5.30 [95% CI, 0.99-28.40]). In diabetics, initiating BP lowering at baseline SBP of 130-140 mm Hg may not produce any benefit but probably increase the risks of serious adverse events and hypotension. It may not be recommended to initiate BP lowering at a threshold of SBP lower than 140 mm Hg for diabetics.
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Wang et al. (2019) conducted a meta-analysis in Diabetes with baseline systolic blood pressure of 130-140 mm Hg (n=21,574). Blood pressure lowering was evaluated on Major cardiovascular events (RR 1.01, 95% CI 0.93-1.10). Initiating blood pressure lowering at a baseline systolic blood pressure of 130-140 mm Hg in patients with diabetes did not reduce major cardiovascular events (RR 1.01; 95% CI 0.93-1.10).
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