Michael E. Farkouh, MD, MSc
What is the optimum systolic blood pressure (SBP) target for patients with type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), or glucose intolerance (IGT)?
Included studies evaluated antihypertensive therapy, enrolled ≥ 100 patients with T2DM/IFG/IGT, achieved mean SBP ≤ 135 mm Hg in the intensive SBP control group and ≤ 140 mm Hg in the standard SBP control group, and had a difference between groups ≥ 3 mm Hg. Outcomes had to be assessed at ≥ 1 year and included all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, heart failure, overt nephropathy, and serious adverse events.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials (all to Oct 2010), and reference lists of identified studies and reviews were searched for randomized controlled trials (RCTs). 13 RCTs (n = 37 736, mean age range 55 to 67 y, 35% to 82% men) were included. 4 RCTs compared an intensive with a standard BP strategy by design, 5 compared a single drug with placebo, and 4 compared 2 drugs. In each trial, 1 treatment group was identified as “intensive SBP control” and the other as “standard SBP control.” 10 trials had low risk for bias, and 3 had unclear or high risk for bias based on 6 criteria.
Intensive SBP control reduced risk for all-cause mortality, stroke, and overt nephropathy compared with standard SBP control (Table). Intensive SBP control increased risk for serious adverse events (odds ratio 1.20, 95% CI 1.08 to 1.32).
In patients with type 2 diabetes/impaired fasting glucose/glucose intolerance, interventions that decrease systolic blood pressure to ≤ 135 mm Hg reduce mortality, stroke, and overt nephropathy more than interventions that decrease systolic blood pressure to ≤ 140 mm Hg.
*CV = cardiovascular; IFG = impaired fasting glucose; IGT = glucose intolerance; MI = myocardial infarction; SBP = systolic blood pressure; T2DM = type 2 diabetes mellitus; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from control event rates and odds ratios in article using a fixed-effect model.
Farkouh ME. Review: Lowering systolic BP to ≤ 135 mm Hg reduces CV events in type 2 diabetes/IFG/IGT. Ann Intern Med. 2011;155:JC5–3. doi: 10.7326/0003-4819-155-10-201111150-02003
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Published: Ann Intern Med. 2011;155(10):JC5-3.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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