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Blood Pressure Lowering in Type 2’s Leads to Lower Risk of CVD and Improved Mortality

Blood pressure-lowering treatment among patients with type 2 diabetes is associated with a lower risk of cardiovascular disease (CVD) and heart disease events and improved mortality, according to a study…

By 2030, it is estimated that there will be at least 400 million individuals with type 2 diabetes mellitus worldwide. Type 2 diabetes is associated with a substantially increased risk of events such as heart attack and stroke. Blood pressure (BP) levels are on average higher among individuals with diabetes and increased BP is a well-established risk factor for people with diabetes. Lowering BP in individuals with diabetes is an area of current controversy, with particular debate surrounding who should be offered therapy and the BP targets to be achieved, according to background information in the article.

Kazem Rahimi, D.M., M.Sc., of the George Institute for Global Health, University of Oxford, Oxford, U.K., and colleagues conducted a review and meta-analysis of large-scale randomized controlled trials of BP-lowering treatment including patients with diabetes, published between January 1966 and October 2014. A search of the medical literature identified 40 trials judged to be of low risk of bias (100,354 participants), and were included in the analysis to examine the associations between BP-lowering treatment and vascular disease in type 2 diabetes.

The researchers found that each 10-mm Hg lower systolic BP was associated with a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria (the presence of excessive protein in the urine), and retinopathy (loss of vision related to diabetes). The associations between BP-lowering treatments and outcomes were not significantly different, irrespective of drug class, except for stroke and heart failure.

Although proportional associations of BP ­lowering treatment for most outcomes studied were diminished below a systolic BP level of 140 mm Hg, data indicated that further reduction below 130 mm Hg is associated with a lower risk of stroke, retinopathy, and albuminuria, potentially leading to net benefits for many individuals at high risk for those outcomes.

“Among patients with type 2 diabetes, BP lowering was associated with improved mortality and other clinical outcomes. These findings support the use of medications for BP lowering in these patients,” the authors write.

Practice Pearls:

  • That each 10-mm Hg lower systolic BP was associated with a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria.
  • Data indicated that further reduction below 130 mm Hg is associated with a lower risk of stroke, retinopathy, and albuminuria, potentially leading to net benefits for many individuals at high risk for those outcomes.
  • The findings support the use of medications for BP lowering in these patients,” the authors write.

Connor Emdin. Blood Pressure Lowering in Type 2 Diabetes, A Systematic Review and Meta-analysis. JAMA, pub Feb 10, 2015, JAMA. 2015;313(6):603-615. doi:10.1001/jama.2014.18574.