Comparing high blood pressure treatment options for patients with diabetes

This study compared the effects of different treatments for high blood pressure (hypertension) in patients with diabetes. The authors concluded that patients with type 2 diabetes benefited from hypertensive treatment if they had high systolic blood pressure (above 140 mm Hg). No significant differences were observed between different types of treatments in reducing mortality risk, cardiovascular disease, or kidney disease.

The risk of cardiovascular complications such as heart attacks, strokes, heart failure, and mortality is increased in patients with diabetes. Hypertension is also more common in patients with diabetes than in the general population. Treatment of hypertension can lower the risk of cardiovascular complications and kidney disease.

Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, calcium channel blockers, and diuretics are all used to treat hypertension. How these treatment options can reduce cardiovascular risk in patients with diabetes compared to the general population is still being investigated. It is also unclear at what blood pressure level treatment is beneficial for these patients. 

This study pooled the results from 11 separate review studies into a single analysis to examine the effectiveness of hypertensive treatments in patients with diabetes. Each study included was a review of several trials, involving a total of 529,644 patients with diabetes.

4 studies looked at the relationship between systolic blood pressure (SBP – pressure when the heart is contracting) and the effectiveness of hypertensive treatment. The average age of patients was 60 years and most had type 2 diabetes. When SBP was less than 140 mm Hg, treatment was less effective at reducing the risk of heart disease. Treatment increased the risk of mortality when SBP was less than 140 mm Hg. When SBP was greater than 140 mm Hg, hypertensive treatment reduced the risk of mortality, cardiovascular disease, stroke, heart attack, and heart failure.

8 of the studies included compared different hypertensive treatments. These included ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, and diuretics. Most of the patients had type 1 diabetes or were elderly with type 2 diabetes. No significant differences were observed between treatments at reducing the risk of mortality, cardiovascular disease, kidney disease, or heart disease. Calcium channel blockers were more effective at reducing the risk of stroke. Diuretics were particularly effective at reducing the risk of heart failure.

The authors concluded that patients with type 2 diabetes benefited from hypertensive treatment if their systolic blood pressure is greater than 140 mm Hg. No significant differences were observed between different types of treatments in reducing mortality risk, cardiovascular disease, or kidney disease.