Diabetes and Cardiovascular Disease (ND Wong, Section Editor)

Current Cardiology Reports

, Volume 14, Issue 1, pp 89-96

Tight Blood Pressure Control in Diabetes: Evidence-Based Review of Treatment Targets in Patients with Diabetes

  • Gianpaolo ReboldiAffiliated withDepartment of Internal Medicine, University of Perugia Email author 
  • , Giorgio GentileAffiliated withDepartment of Internal Medicine, University of Perugia
  • , Valeria Maria ManfredaAffiliated withNephrology and Dialysis Unit, Bolognini Hospital
  • , Fabio AngeliAffiliated withDivision of Cardiology, Hospital S. Maria della Misericordia
  • , Paolo VerdecchiaAffiliated withDivision of Internal Medicine, Hospital of Assisi

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Abstract

Blood pressure (BP) targets in diabetic patients stills represent the object of a major debate, fueled by the recent publication of post hoc observational analyses of the INVEST and the ONTARGET trials, suggesting an increased risk of cardiovascular events with tighter control, the J-curve effect, and by the results of the ACCORD trial, showing no improvements in the composite primary outcome of nonfatal myocardial infarction, stroke, or cardiovascular death in the intensive BP-lowering arm (<120/80 mmHg). In the present review, we focus on existing evidence about different BP targets in diabetic subjects and we present the results of our recent meta-analysis, showing that tight BP control may significantly reduce the risk of stroke in these patients without increasing the risk of myocardial infarction. Therapeutic inertia (leaving diabetic patients with BP values of 140/90 mmHg or higher) should be avoided at all costs, as this would lead to an unacceptable toll in terms of human lives, suffering, and socioeconomic costs.

Keywords

Diabetes mellitus Hypertension Stroke Myocardial infarction Cardiovascular diseases Evidence-based medicine Evidence-based practice Blood pressure control