Early blood pressure control reduces atherosclerotic event risk

Raghavan S, Ho YL, Kini V et al (2019) Association between early hypertension control and cardiovascular disease incidence in veterans with diabetes. Diabetes Care 42: 1995–2003

• Good blood pressure control reduces the risk of cardiovascular disease; however, the target blood pressure and optimal threshold at which to initiate antihypertensive treatment remain unclear in adults with diabetes.
• In this retrospective study, researchers followed almost 44,000 individuals with diabetes who were started on antihypertensive therapy over a 5-year period to determine the impact systolic blood pressure (SBP) had on atherosclerotic cardiovascular disease events (fatal and non-fatal stroke and myocardial infarction).
• Patients were split into groups according to their SBP when starting antihypertensive treatment and 2 years later.
• Patients with higher pre-treatment SBP (³140 mmHg) had a greater risk of atherosclerotic cardiovascular disease events during the 9.3-year follow-up period than those with lower pre-treatment SBP (130–139 mmHg); this risk remained higher in patients who achieved on-treatment SBP of 120–129 mmHg when compared to those with a pre-treatment SBP of 130–139 mmHg.
• There was a higher risk of adverse outcomes in individuals with higher on-treatment SBP at 2 years when compared to those with lower on-treatment SBP at this point in time.
• It was concluded that better outcomes resulted from starting antihypertensive treatment when SBP was 130–139 mmHg and when achieving on-treatment SBP of <130 mmHg.

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