Blood Pressure Targets for Hypertension in Patients with Type 2 Diabetes
Background: Clinical guidelines vary in determining optimal blood pressure targets in adults with diabetes mellitus. Methods: We systematically searched PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov in March 2018; conducted random effects frequentist meta-analyses of direct aggregate data; and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: From eligible 14 meta-analyses and 95 publications of randomized controlled trials (RCT), only 6 RCTs directly compared lower versus higher blood pressure targets; remaining RCTs aimed at comparative effectiveness of hypotensive drugs. In adults with diabetes mellitus and elevated systolic blood pressure (SBP), direct evidence (2 RCTs) suggests that intensive target SBP /=90 mmHg, direct evidence (2 RCTs) suggests that intensive DBP target =80 versus 80-90 mmHg decreases the risk of major cardiovascular events. Published meta-analyses of aggregate data suggested a significant association between lower baseline and attained blood pressure and increased cardiovascular mortality. Conclusions: We concluded that in adults with diabetes mellitus and arterial hypertension, in order to reduce the risk of stroke, clinicians should target blood pressure at 120-130/80 mmHg, with close monitoring for all drug-related harms.
Aronow, W. S., & Shamliyan, T. (2018). Blood Pressure Targets for Hypertension in Patients with Type 2 Diabetes. Annals of Translational Medicine, 6 (11), 199. https://doi.org/10.21037/atm.2018.04.36