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February 18, 2015
Blood Pressure Medications Lower Mortality, CV Disease in Diabetes Patients
Oxford, England—When should blood pressure–lowering treatment begin in patients with type 2 diabetes and how low should it go? Those are some of the most difficult questions debated about hypertension control in diabetic patients. A new study helps provides some answers, however. The report, published recently in the Journal of the American Medical Association, finds that blood pressure–lowering treatment among patients with type 2 diabetes is associated with a lower risk of cardiovascular disease (CVD) and heart disease events as well as improved mortality. The study, led by researchers from the George Institute for Global Health at the University of Oxford, found that each 10-mm Hg lower systolic blood pressure (BP) was associated with a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria, and retinopathy. The results were from a meta-analysis of large-scale randomized controlled trials of BP-lowering treatment including patients with diabetes, published between January 1966 and October 2014. Researchers focused on 40 trials with 100,354 participants considered to have low risk of bias. “Among patients with type 2 diabetes, BP lowering was associated with improved mortality and other clinical outcomes. These findings support the use of medications for BP lowering in these patients,” the authors write. Background information in the report notes that, by 2030, as many as 400 million individuals are expected to have type 2 diabetes mellitus worldwide. Type 2 diabetes is associated with a substantially increased risk of CVD, and BP levels generally are higher in that group. The authors also point out that lowering BP in individuals with diabetes is an area of current controversy, with particular debate surrounding who should be offered therapy and the BP targets to be achieved. An accompanying editorial written by Bryan Williams, MD, of the University College London, notes that the study suggests that, for some patients, current treatment thresholds and targets “might be too conservative, especially for optimally reducing the risk of stroke and the development or progression of albuminuria. “This conundrum highlights the problems with clinician overreliance on guidelines and guideline overdependence on an often, uncritical adoption of evidence, despite the limitations of the clinical trials. Guidelines are just that, and are necessarily conservative in providing population-based recommendations that physicians must interpret in the context of the individual patient being treated."
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U.S. Pharmacist Social Connect
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