Intensive BP lowering beneficial for type 2 diabetes patients

CHINA: Intensive blood pressure (BP) lowering treatment provides greater benefits in patients with type 2 diabetes compared with less intensive treatment, finds a recent study published in the journal PLOS One. Benefits include reductions in mortality risk, major cardiovascular (CV) events, CV death, myocardial infarction (MI), stroke, and albuminuria progression.

Diabetes mellitus (DM) is a global public health problem. DM is estimated to affect 400 million individuals worldwide by the year 2030. People with DM are at high risk of cardiovascular (CV) events, such as stroke and MI, and all-cause mortality at any level of blood pressure.

Previous studies have shown the role of intensive BP lowering in reducing the risk of all-cause mortality and providing vascular protection to patients with hypertension. No study until now has evaluated whether BP lowering treatment is associated with such benefits in patients with type 2 diabetes mellitus. Jing Wang, School of Medicine, Nankai University, Tianjin, China, and colleagues conducted a new systematic review and meta-analysis that only included RCTs aimed at evaluating the effects of intensive BP lowering treatment to investigate whether more intensive BP control compared with less intensive BP control was associated with a reduced mortality risk and better CV and renal outcomes in diabetic patients.

For the purpose, the researchers searched for databases to identify randomized controlled trials (RCT) that fulfilled study inclusion criteria. The meta-analysis included 16 RCTs.

Key findings of the study include:

• Intensive BP lowering treatment vs less intensive BP lowering treatment resulted in significant reductions in the all-cause mortality risk, major CV events, MI, stroke, CV death, and albuminuria progression.


• However, intensive BP lowering treatment had no clear effect on non-CV death, heart failure (HF) or end-stage kidney disease (ESKD).


• Subgroup analysis showed that the reduction in all cause-mortality was consistent across most patient groups, and intensive BP lowering treatment had a clear benefit even in patients with systolic blood pressure lower than 140 mm Hg. However, the benefit differed in patients with different CV risk.

"This systematic review and meta-analysis provide clear evidence of the benefits of intensive BP lowering treatment for type 2 diabetic patients. The results also provide some supporting evidence for the latest BP guideline of lowering BP to a goal of <130/80 mm Hg," write the authors.

"However, more well-designed RCTs are needed to further evaluate the benefits or harms of a goal of <130/80 mm Hg with intensive BP lowering treatment," they concluded.