[acb-diabetics] maintaining BP below 2130 may not be good for those with CAD

[Patricia LaFrance-Wolf]

uTight Blood Pressure Control Associated with Worse Outcomes for Diabetes
and Heart Disease Patients

 

Patients with hypertension, diabetes and coronary artery disease who
maintained their systolic blood pressure at less than 130 mm Hg, as
recommended by

the American Diabetes Association, did not have improved cardiovascular
outcomes compared to patients with usual blood pressure control, according
to a

study....

 

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"Hypertension guidelines advocate treating systolic blood pressure (BP) to
less than 130 mm Hg for patients with diabetes mellitus; however, data are
lacking

for the growing population who also have coronary artery disease (CAD),"
according to background information in the article.  

 

Rhonda M. Cooper-DeHoff, Pharm.D., M.S., of the University of Florida,
Gainesville, and colleagues examined whether patients with hypertension,
diabetes

and CAD who achieved systolic BP of less than 130 mm Hg would have a reduced
risk of cardiovascular events compared with those who managed to keep their

systolic BP within the range of at least 130 mm Hg to less than 140 mm Hg.
The analysis included 6,400 of the 22,576 participants in the International

Verapamil SR-Trandolapril Study (INVEST). For this analysis, participants
were at least 50 years old and had diabetes and CAD. Participants were
recruited

between September 1997 and December 2000 from 862 sites in 14 countries and
were followed up through March 2003, with an extended follow-up through
August

2008 through the National Death index for U.S. participants.  

 

Patients received treatment with either a calcium antagonist or beta-blocker
followed by angiotensin-converting enzyme inhibitor, a diuretic, or both to

achieve systolic BP of less than 130 and diastolic BP of less than 85 mm Hg.
Patients were categorized as having tight control if they could maintain
their

systolic BP at less than 130 mm Hg; usual control if systolic BP ranged from
130 mm Hg to less than 140 mm Hg; and uncontrolled if systolic BP was 140

mm Hg or higher. The primary outcome included the occurrence of all-cause
death, nonfatal myocardial infarction (heart attack), or nonfatal stroke.  

 

The primary outcome occurred in 12.7 percent (286 patients) of those in the
tight-control group, 12.6 percent (249 patients) of the usual-control group,

and 19.8 percent (431 patients) of the uncontrolled groups. When evaluating
all-cause mortality for the entire follow-up period, after adjustment, risk

of all-cause mortality was significantly greater in the tight-control group
(22.8 percent) than in the usual-control group (21.8 percent). 

 

"In this observational study, we have shown for the first time, to our
knowledge, that decreasing systolic BP to lower than 130 mm Hg in patients
with diabetes

and CAD was not associated with further reduction in morbidity beyond that
associated with systolic BP lower than 140 mm Hg, and, in fact, was
associated

with an increase in risk of all-cause mortality. Moreover, the increased
mortality risk persisted over the long term," the authors write. 

 

"At this time, there is no compelling evidence to indicate that lowering
systolic BP below 130 mm Hg is beneficial for patients with diabetes; thus,
emphasis

should be placed on maintaining systolic BP between 130 and 139 mm Hg while
focusing on weight loss, healthful eating, and other manifestations of
cardiovascular

morbidity to further reduce long-term cardiovascular risk." 

 

JAMA, July 7, 2010 

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