Blood pressure treatment target in patients with diabetes mellitus--current evidence.

Institute of Clinical Medicine/Internal Medicine, University of Oulu, Oulu, Finland.
Annals of Medicine (Impact Factor: 4.73). 06/2012; 44 Suppl 1:S36-42. DOI: 10.3109/07853890.2012.679961
Source: PubMed

ABSTRACT Hypertension is a very common cardiovascular disease (CVD) risk factor in diabetes, affecting more than half of diabetic patients. Major guidelines on the management of hypertension recommend to start antihypertensive drugs in all diabetic patients with a systolic blood pressure (SBP) 140 mmHg or more and/or a diastolic blood pressure (DBP) 90 mmHg or more, and to adjust the treatment strategy in order to lower their BP below these values. The present body of evidence suggests that in patients with type 2 diabetes mellitus/impaired fasting glucose/impaired glucose tolerance, a SBP treatment goal of 130 to 135 mmHg is acceptable. Aiming at SBP levels of 130 mmHg decreases stroke risk, but the risk of serious adverse events may increase with very low BP levels. The results regarding the attained DBP level is somewhat complex, since middle-aged people with diastolic hypertension and pre-existing CVD may have increased CVD mortality if their DBP is lowered drastically to a very low level. With the currently available very limited trial data on low attained BP level, it is not possible to set a specific treatment target regarding BP levels for diabetic hypertensive patients, but it is important to use a personalized approach in their antihypertensive treatment.

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    ABSTRACT: Hypertension is a modifiable risk factor for cardiovascular disease. Lowering blood pressure (BP) reduces cardiovascular risk; yet despite the availability of numerous antihypertensives, the proportion of patients achieving BP control remains low. Treatment guidelines are based on evidence from clinical trials, however this evidence may not be representative of real-world treatment effectiveness. Many studies evaluating antihypertensives continue to rely on office BP measurements that provide a less realistic evaluation of hypertension status than ambulatory measures. New studies are needed with greater consideration on evaluating efficacy for translation into clinical effectiveness. In addition, novel therapies for reducing BP and with a greater capacity to improve BP control are still required. This article discusses some of the challenges of hypertension management and reviews strategies and treatment advances that may pave the way to more effective BP control.
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