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A large study urges caution in people with diabetes with regard to optimising blood pressure

How low should you go with blood pressure reduction in people with diabetes? NICE's QOF advisory committee is suggesting ever-lower blood pressure targets, but is this based on science? A large study urges caution in people with diabetes and suggests an optimum blood pressure level.

Dr Gang Hu, an author on this study, said: “we should pay attention not only to the harm of uncontrolled blood pressure, but also to aggressively controlled blood pressure. My advice for individual clinicians is the idea of ‘the lower, the better’ should pass away … Patients need individualized or tailored treatment for their hypertension.”

You can see why – in this very large prospective cohort study 30,154 patients with diabetes, based in primary care, were followed up for 6 years. There was a U-shaped association – with increased risks at both ends of the systolic blood pressure (BP) spectrum and an optimal BP in between. Adjusting for variables, with either systolic or diastolic BP viewed as a continuous parameter, the optimum BP for coronary heart disease risk reduction would appear to be at systolic BP 130–140 mmHg and diastolic BP 80–90 mmHg.

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