U-shaped Relationship of Blood Pressure to CVD Risk and Relevance to Treatment Goals in Diabetes
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- Nilsson, P.M. Curr Cardiovasc Risk Rep (2014) 8: 369. doi:10.1007/s12170-013-0369-y
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A heated debate has developed on the blood pressure goal for treatment of hypertension in patients with type 2 diabetes. The evidence for going below 130 mmHg systolic blood pressure has been found to be weak and that is why new guidelines have advocated a somewhat more conservative view, aiming for a blood pressure goal <140/85 mmHg in European guidelines and <140/80 mmHg in American guidelines from 2013. One important argument has been the description of a J-shaped curve for associations between achieved blood pressure levels in the trials and risk of cardiovascular events. These observational data have contributed to the change in attitudes for defining blood pressure goals in patients with type 2 diabetes, and will be briefly summarised here. Not only post hoc observational data from clinical trials will be discussed but also observational data from a National Diabetes Register, covering 2/3 of all diabetes patients in Sweden.