February 15, 2017
View Full PaperEffects of blood-pressure-lowering treatment on outcome incidence in hypertension
Structured PICO
Does blood-pressure-lowering treatment reduce cardiovascular and ESRD risk differently in hypertensive patients with versus without diabetes mellitus?
P
Population
Hypertensive patients with and without diabetes mellitus
I
Intervention
Blood-pressure-lowering treatment (including renin-angiotensin system blockers)
O
Outcome
Cardiovascular risk and end-stage renal disease (ESRD) riskhard clinical
Blood pressure lowering reduces cardiovascular risk in all hypertensive patients, but targeting SBP <130 mmHg provides additional benefit only in those without diabetes, challenging past recommendations.
Abstract
BP-lowering treatment significantly and importantly reduces cardiovascular risk both in diabetes mellitus and no diabetes mellitus, but evidence for reduced ESRD risk is available only in diabetes. Contrary to past recommendations, in diabetes mellitus there is little or no further benefit in lowering SBP below 130 mmHg, whereas continuing benefit is seen in no diabetes mellitus also at SBP below 130 mmHg. Although all BP-lowering drugs can beneficially be prescribed in hypertensive patients with diabetes mellitus, the current recommendation to initiate or include a renin-angiotensin system blocker is supported by the evidence here presented.