In a nutshell
This study investigated the ideal blood pressure target for people with type 2 diabetes (T2D). It was determined that a systolic blood pressure (SBP, pressure when the heart contracts) of 130-139 mmHg reduced complications of high blood pressure, but there was limited evidence that lowering of SBP below 130 mmHg had benefits, and that complications might increase if SBP was less than 120 mmHg. It was also determined that diastolic blood pressure (DBP, pressure when the heart is at rest) values as low as 70 mmHg may reduce complications.
Some background
People with T2D have a higher risk of developing high blood pressure than people without T2D. High blood pressure is associated with complications like heart attacks, stroke, and chronic kidney disease. Reducing blood pressure reduces the risks of complications. However, the exact amount blood pressure should be reduced to is uncertain.
Methods & findings
This study examined evidence from different studies of people with T2D. Some participants in these studies were given a target blood pressure of less than 140/90mmHg. Others were given a target of less than 130/80mmHg.
Reducing SBP below 140 mmHg reduced complications. One large trial determined that lowering SBP to roughly 134 mmHg reduced the risk of cardiovascular mortality by 18%. The closer the SBP was to 130mmHg, the more complications were reduced. Multiple studies noted that reducing SBP below 130mmHg reduced the risk of stroke. However, the effect of lowering SBP to less than 130mmHg on other complications (such as heart attacks) was less certain. Some studies found a benefit, others found only a small benefit, or none at all. Overall, lowering SBP to less than 120mmHg increased the risks of complications.
Lowering DBP to values lower than 80mmHg reduced the risk of complications. DBP as low as 70mmHg can also be beneficial, without increasing the risk of complications.
The bottom line
The study determined that SBP values close to, but not less than, 130mmHg may be best for most people with T2D, but certain people might benefit from lower values (such as those with an increased risk of having a stroke). SBP values lower than 120mmHg should be avoided. They also concluded that DBP values between 70mmHg and 80mmHg may be beneficial.
The fine print
Blood pressure is just one factor that increases the risk of heart attacks, strokes, and chronic kidney disease. Different people have different combinations of factors that increase or decrease their risk of these complications. Thus a target for blood pressure in one individual with T2D will not apply to all individuals with T2D.
What’s next?
Discuss a plan for managing your blood pressure with your physician.
Published By :
Diabetologia
Date :
Jan 25, 2018
