Does blood-pressure-lowering treatment reduce cardiovascular and ESRD risk differently in hypertensive patients with versus without diabetes mellitus?
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.
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.
Thomopoulos et al. (2017) studied this question.