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What Is the Proper Blood Pressure Target for Diabetes Patients?

US researchers performed a systematic review and meta-analysis of randomized controlled trials of intensive vs standard blood pressure control in patients with diabetes or impaired fasting glucose. They identified 13 suitable studies that included 37,736 enrollees. “Intensive BP control was associated with a 10% reduction in all-cause mortality (odds ratio, 0.90), a 17% reduction in stroke, and a 20% increase in serious adverse effects, but with similar outcomes for other macrovascular and microvascular (cardiac, renal, and retinal) events compared with standard BP control. More intensive BP control (130 mm Hg) was associated with a greater reduction in stroke, but did not reduce other events. Meta-regression analysis showed continued risk reduction for stroke to a systolic BP of <120 mm Hg. However, at levels <130 mm Hg, there was a 40% increase in serious adverse events with no benefit for other outcomes." "In patients with type 2 diabetes /impaired fasting glucose/impaired glucose tolerance, a systolic BP treatment goal of 130 to 135 mm Hg is acceptable." "However, with more aggressive goals (<130 mm Hg), we observed target organ heterogeneity in that the risk of stroke continued to fall." Circulation 123(24):2799-2810, 21 June 2011