Intensive Blood Pressure Targets for Diabetic and Other High-Risk Populations

Abstract

Optimal blood pressure (BP) targets for different populations, especially diabetics, remain uncertain after conflicting data on intensive management. We assessed whether a <120 mm Hg systolic target is beneficial and whether certain patient populations differ in response. Individual patient data of 14 094 patients from 2 randomized control trials was pooled. Seven thousand forty patients were assigned to an intensive target of <120 mm Hg and 7054 patients to a standard target of <140 mm Hg in an intention-to-treat analysis. The primary outcome was a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular mortality. Interactions between treatment and baseline characteristics were assessed. Secondary outcomes included nonfatal myocardial infarction, stroke, heart failure, cardiovascular mortality, and overall mortality. Intensive management significantly lowered primary outcome rate (hazard ratio, 0.83; 95% confidence interval, 0.74-0.92; <0.001). No significant interaction was observed between treatment effect and diabetes mellitus status (=0.16). Significantly reduced secondary outcomes included stroke (hazard ratio, 0.75; =0.033) and heart failure (hazard ratio, 0.76;=0.014). No significant interactions were observed between treatment effect and baseline age, sex, race, cardiovascular disease history, systolic BP, or diastolic BP ( values: 0.40, 0.95, 0.54, 0.18, 0.86, and 0.67, respectively). BP targets of <120 mm Hg improved cardiovascular outcomes. Diabetic patients responded similarly to this intervention, as did those with different age, sex, cardiovascular disease history, baseline BPs, and race. The intensive group had increased risk of intervention-related adverse outcomes (3.97% versus 1.53%; <0.001). Clinicians should consider <120 mm Hg systolic targets for a variety of patients, including diabetics.

Potential impact of the 2017 ACC/AHA guideline on high blood pressure in normotensive patients with stable coronary artery disease: insights from the CLARIFY registry

“…In addition, 33% of the ACCORD, and 17% of the SPRINT populations had a previous cardiovascular event, which leaves very few patients with normotension and coronary artery disease. Overall, even though the combined analysis of these trials favoured intensive treatment, 13 no clear conclusion can be drawn on intensive BP-lowering in normotensive patients with coronary artery disease. Noteworthy, in SPRINT, mean age was 7 years older than in CLARIFY, and patients with diabetes or previous stroke were excluded, also limiting the comparison between these two studies.…”

A simple nomogram score for screening patients with type 2 diabetes to detect those with hypertension: A cross-sectional study based on a large community survey in China

“…Besides, Rahul Aggarwal reported that the combination of T2DM and hypertension is more likely to be associated with person who is older, male, higher BMI and less physical activity [ 33 ], a reasonable diet, exercise, weight control, and central obesity control are useful in preventing hypertension [ 34 – 37 ]. Previous studies have also provided us with evidence of aggravation of organ damage caused by alcohol in diabetic patients [ 38 ].…”

Blood pressure levels and risk of cardiovascular disease mortality among Japanese men and women

“…The causal relations need to be determined through randomized controlled trials, as observational study designs have inevitable drawbacks (eg confounding factors). As mentioned, some clinical trials have shown the benefit of lowering BP below 'normal' levels among strictly selected patients [3]. However, in general practice, patients with hypertension alongside comorbidities such as atherosclerosis, atrial fibrillation, and heart failure are sometimes unintentionally treated to low BP levels, Therefore, the objective of the current study is to provide reliable information on the relationship between baseline BP levels and long-term mortality from CVD in a large sample and use differential analysis to examine whether the association varied by antihypertensive medication use.…”

“…It is well known that high blood pressure (BP) increases the risk of cardiovascular disease (CVD) [1], and that treatment of hypertension reduces that risk [2]. Clinical trials have shown that treating hypertension to below-normal BP levels is better for the prevention of coronary heart disease or stroke among patients with high cardiovascular risk [3]. On the other hand, several prospective cohort studies have shown that among patients treated for hypertension treatment to low BP levels was associated with increased risk of coronary heart disease and/or stroke compared with treatment to moderate BP levels [4][5][6][7][8].…”

“…[13] A recent study pooling 2 randomized controlled trials(SPRINT and ACCORD) demonstrated that intensive treatment targeting <120 mmHg systolic BP significantly --lowered risk of CVD mortality (HR = 0.83 [0.74-0.92]) compared to standard treatment targeting <140 mmHg[3]. A network meta-analysis of 42 trials including 144,220 patients found the lowest incidence and mortality from CVD in the 120 to 124 mmHg systolic BP category compared with the higher categories, although they did not examine the risk below 120 mmHg[14].…”