Systolic BP treatment goal of 130 to 135 mm Hg acceptable in Type 2 diabetes

In patients with type 2 diabetes mellitus/impaired fasting glucose/impaired glucose tolerance, a systolic BP treatment goal of 130 to 135 mm Hg is acceptable, according to the results of a meta-analysis published online in June 1, 2011 issue of Circulation.

Sripal Bangalore, MD, MHA, Assistant Professor of Medicine,  from, New York University School of Medicine, USA and colleagues performed a meta-analysis of randomized clinical trials from 1965 to October 2010 of antihypertensive therapy in patients with type 2 diabetes mellitus or impaired fasting glucose/impaired glucose tolerance that enrolled at least 100 patients with achieved systolic BP of 135 mm Hg in the intensive BP control group and 140 mm Hg in the standard BP control group, had a follow-up of at least 1 year, and evaluated macrovascular or microvascular events.

They found that intensive BP control was associated with a 10% reduction in all-cause mortality, 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.

The authors also reported that with more aggressive goals (<130 mm Hg), they observed target organ heterogeneity in that the risk of stroke continued to fall, but there was no benefit regarding the risk of other macrovascular or microvascular (cardiac, renal and retinal) events, and the risk of serious adverse events even increased.