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Optimal blood pressure targets in diabetes

Recent NICE guidance suggested a blood pressure target in diabetes of 140/80 mmHg (below 130/80 mmHg if there is kidney, eye or cerebrovascular damage). Other authorities have debated this target level, though, and so the investigators set about assessing the effect of antihypertensive treatment on mortality and cardiovascular morbidity at different blood pressure levels. They found that antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with a diagnosis of diabetes and a systolic blood pressure more than 140 mmHg, but that below this level further treatment is associated with an increased risk of cardiovascular death with no observed benefit.

By Colin Kenny, GP, Dromore

Although people with diabetes have been included in many trials of blood pressure-lowering treatment, for most of these a diabetes “cut” has not been published separately. Here, investigators performed a systematic review and meta-analysis, guided by Cochrane Collaboration recommendations. Forty-nine trials, corresponding to 73,738 participants in all, fulfilled the inclusion criteria for the meta-analysis.

In people with diabetes and a systolic blood pressure of more than 140 mmHg, antihypertensive treatment is associated with a reduced risk of mortality and cardiovascular disease. If systolic blood pressure is less than 140 mmHg, however, further treatment is associated with an increased risk of cardiovascular death, with no observed benefit.

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