Does intensive blood pressure control provide beneficial outcomes for patients with diabetes?

This study investigated whether a systolic blood pressure (SBP) of 120 mm Hg or less is beneficial for patients with diabetes, and determined their outcomes. This study concluded that this intensive blood pressure control improves cardiovascular outcomes in those with diabetes.

Proper management of blood pressure (BP) in diabeties has been controversial since the early 2000s. Systolic blood pressure (SBP) recommendations fluctuated from less than 130 mm Hg to less than 140 mm Hg. The latest BP recommendation for adults with diabetes by the American Heart Association is 130/80 mm Hg.

Previous research has found no benefit for intensive BP control (less than 120 mm Hg) in diabetes. However, this finding has been controversial. Whether or not diabetes patients respond differently and have similar cardiovascular benefits compared to patients without diabetes is unclear.

This study involved 14,094 patients. 49.9% of patients were assigned to the intensive SBP group (less than 120) and 50% of patients were assigned to the standard SBP group (less than 140).

The intensive group had significantly fewer heart-related events compared to the standard group. The overall incidence rate was 2.21% (intensive) and 2.68% (standard). The intensive group also had lower rates of stroke (0.37%) and heart failure (0.55%) compared to the standard group (0.50%, stroke; 0.73%, heart failure). These differences were all statistically significant.

The intensive SBP treatment was associated with decreased risk of heart-related events (by 17%), stroke (by 25%), and heart failure (by 24%). These were statistically significant. No statistically significant differences in cardiovascular mortality, overall mortality, and nonfatal heart attack were observed between the groups. No statistically significant difference was observed for diabetic patients.

3.97% of patients in the intensive group and 1.53% of patients in the standard group reported side effects. These were related to their BP intervention. This difference was statistically significant.

This study concluded that intensive blood pressure control improves cardiovascular outcomes, and that this benefit extends to patients with diabetes.

This study analyzed patient data from two large, multicenter studies: the ACCORD study and the SPRINT study. Both studies investigated the intensive SBP and standard SBP targets, but the SPRINT study excluded diabetics and the ACCORD study population was composed of only patients with diabetes. As a result, it was impossible to separate out the diabetes status from other inclusion criteria, such as cardiovascular risk. More studies are needed to investigate blood pressure targets in patients that do not have high cardiovascular risk.

Lastly, both the ACCORD and SPRINT studies used automated blood pressure measurements. These automated measurements tend to be lower than those taken manually at a doctor’s office.