Current Cardiology Reports

, Volume 14, Issue 1, pp 89–96 | Cite as

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

  • Gianpaolo Reboldi
  • Giorgio Gentile
  • Valeria Maria Manfreda
  • Fabio Angeli
  • Paolo Verdecchia
Diabetes and Cardiovascular Disease (ND Wong, Section Editor)


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.


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

Clinical Trial Acronyms


Appropriate Blood Pressure Control in Diabetes


Action to Control Cardiovascular Risk in Diabetes


Hypertension Optimal Treatment


International Verapamil SR-Trandolapril Study


Multiple Risk Factor Intervention Trial


Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial


Randomized Olmesartan and Diabetes Microalbuminuria Prevention


Systolic Blood Pressure Intervention Trial


UK Prospective Diabetes Study



Conflicts of interest: G. Reboldi: has received honoraria from Wolters Kluwer Health Italy; has received payment for development of educational presentations including service on speakers’ bureaus for Wolters Kluwer Health Italy, Novo-Nordisk, and Boehringer Ingelheim; and has received travel/accommodations expenses covered or reimbursed from Wolters Kluwer Health Italy, Novo-Nordisk, and Boehringer Ingelheim; G. Gentile: none; V.M. Manfreda: none; F. Angeli: has received honoraria from Pfizer, Takeda, Sanofi-Aventis, and AstraZeneca; and has received payment for development of educational presentations including service on speakers’ bureaus from Pfizer, Takeda, Sanofi-Aventis, and AstraZeneca; P. Verdecchia: has received honoraria from Sanofi-Aventis, Novartis, and Boehringer Ingelheim; and has received travel/accommodations expenses covered or reimbursed from Sanofi-Aventis, Novartis, and Boehringer Ingelheim.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378:31–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Thomas MC, Atkins RC. Blood pressure lowering for the prevention and treatment of diabetic kidney disease. Drugs. 2006;66:2213–34.PubMedCrossRefGoogle Scholar
  3. 3.
    Fong DS, Aiello LP, Ferris 3rd FL, Klein R. Diabetic retinopathy. Diabetes Care. 2004;27:2540–53.PubMedCrossRefGoogle Scholar
  4. 4.
    Tesfaye S, Chaturvedi N, Eaton SE, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352:341–50.PubMedCrossRefGoogle Scholar
  5. 5.
    MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335:765–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43:S1–S290.Google Scholar
  8. 8.
    Williams B, Poulter NR, Brown MJ, et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ. 2004;328:634–40.PubMedCrossRefGoogle Scholar
  9. 9.
    Harris D, Thomas M, Johnson D, et al. The CARI guidelines. Prevention of progression of kidney disease. Nephrology. 2006;11 Suppl 1:S2–S197.PubMedCrossRefGoogle Scholar
  10. 10.
    Khan NA, McAlister FA, Rabkin SW, et al. The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: part II–therapy. Can J Cardiol. 2006;22:583–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Mancia G, De Backer G, Dominiczak A, et al. 2007 guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87.PubMedCrossRefGoogle Scholar
  12. 12.
    Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351:1755–62.PubMedCrossRefGoogle Scholar
  13. 13.
    [No authors listed]. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317:703–13.Google Scholar
  14. 14.
    Estacio RO, Jeffers BW, Gifford N, Schrier RW. Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care. 2000;23 Suppl 2:B54–64.PubMedGoogle Scholar
  15. 15.
    Vijan S, Hayward RA. Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann Intern Med. 2003;138:593–602.PubMedGoogle Scholar
  16. 16.
    •• Cooper-DeHoff RM, Gong Y, Handberg EM, et al. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA. 2010;304:61–8. This post hoc observational study showed little difference between intensive BP control and usual BP control in terms of reduction of cardiovascular event rate. In addition, all-cause mortality rate showed a nonstatistically significant trend toward a higher risk in the tight-control group, compared with the usual-control group. PubMedCrossRefGoogle Scholar
  17. 17.
    •• Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85. In this randomized controlled trial, the incidence of a composite end point of fatal and nonfatal cardiovascular events, and the incidence of MI did not differ significantly between intensive and usual BP control, despite a significant difference in achieved BP values between the two groups. PubMedCrossRefGoogle Scholar
  18. 18.
    Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;27:2121–58.PubMedCrossRefGoogle Scholar
  19. 19.
    •• Reboldi G, Gentile G, Angeli F, et al. Effects of intensive blood pressure reduction on myocardial infarction and stroke in diabetes: a meta-analysis in 73,913 patients. J Hypertens. 2011;29:1253–69. This large meta-analysis demonstrated that intensive BP reduction is clearly appropriate for reducing the risk of stroke, does not increase the risk of coronary events, and may potentially produce coronary benefits. PubMedCrossRefGoogle Scholar
  20. 20.
    Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.PubMedCrossRefGoogle Scholar
  21. 21.
    Adler AI, Stratton IM, Neil HA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000;321:412–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Van den Hoogen PC, Feskens EJ, Nagelkerke NJ, et al. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. N Engl J Med. 2000;342:1–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care. 1993;16:434–44.PubMedCrossRefGoogle Scholar
  24. 24.
    Vatten LJ, Holmen J, Kruger O, et al. Low blood pressure and mortality in the elderly: a 6-year follow-up of 18,022 Norwegian men and women age 65 years and older. Epidemiology. 1995;6:70–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Redon J, Mancia G, Sleight P, et al. Safety and efficacy of low blood pressure among patients with diabetes: sub-group analyses from the ONTARGET trial. J Hypertens. 2011;29(e-Suppl A):e113.Google Scholar
  26. 26.
    Turnbull F, Neal B, Algert C, et al. Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med. 2005;165:1410–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Reboldi G, Gentile G, Angeli F, Verdecchia P. Optimal therapy in hypertensive subjects with diabetes mellitus. Curr Atheroscler Rep. 2011;13:176–85.PubMedCrossRefGoogle Scholar
  28. 28.
    Bjorck S, Mulec H, Johnsen SA, Norden G, Aurell M. Renal protective effect of enalapril in diabetic nephropathy. BMJ. 1992;304:339–43.PubMedCrossRefGoogle Scholar
  29. 29.
    Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993;329:1456–62.PubMedCrossRefGoogle Scholar
  30. 30.
    Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851–60.PubMedCrossRefGoogle Scholar
  32. 32.
    Parving HH, Lehnert H, Brochner-Mortensen J, et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001;345:870–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Rahman M, Pressel S, Davis BR, et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs. a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med. 2005;165:936–46.PubMedCrossRefGoogle Scholar
  34. 34.
    Casas JP, Chua W, Loukogeorgakis S, et al. Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis. Lancet. 2005;366:2026–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Rossing P, Parving HH, de Zeeuw D. Renoprotection by blocking the RAAS in diabetic nephropathy—fact or fiction? Nephrol Dial Transplant. 2006;21:2354–7. discussion 2357–58.PubMedCrossRefGoogle Scholar
  36. 36.
    Suissa S, Hutchinson T, Brophy JM, Kezouh A. ACE-inhibitor use and the long-term risk of renal failure in diabetes. Kidney Int. 2006;69:913–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Ginsberg HN, Elam MB, Lovato LC, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Eng J Med. 2010;362:1563–74.CrossRefGoogle Scholar
  38. 38.
    Bland JM. The tyranny of power: is there a better way to calculate sample size? BMJ. 2009;339.Google Scholar
  39. 39.
    Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349:1269–76.PubMedCrossRefGoogle Scholar
  40. 40.
    Sacco RL, Benjamin EJ, Broderick JP, et al. American Heart Association Prevention Conference. IV. Prevention and rehabilitation of stroke. Risk factors. Stroke. 1997;28:1507–17.PubMedCrossRefGoogle Scholar
  41. 41.
    Bell DS. Stroke in the diabetic patient. Diabetes Care. 1994;17:213–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Sander D, Sander K, Poppert H. Review: stroke in type 2 diabetes. Br J Diabetes Vasc Dis. 2008;8:222–9.CrossRefGoogle Scholar
  43. 43.
    Hankey GJ, Jamrozik K, Broadhurst RJ, et al. Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke. 1998;29:2491–500.PubMedCrossRefGoogle Scholar
  44. 44.
    Megherbi SE, Milan C, Minier D, et al. Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project. Stroke. 2003;34:688–94.PubMedCrossRefGoogle Scholar
  45. 45.
    Nannetti L, Paci M, Baccini M, et al. Recovery from stroke in patients with diabetes mellitus. J Diabetes Compl. 2009;23:249–54.CrossRefGoogle Scholar
  46. 46.
    Luchsinger JA, Tang MX, Stern Y, et al. Diabetes mellitus and risk of Alzheimer’s disease and dementia with stroke in a multiethnic cohort. Am J Epidemiol. 2001;154:635–41.PubMedCrossRefGoogle Scholar
  47. 47.
    Olsson T, Viitanen M, Asplund K, et al. Prognosis after stroke in diabetic patients. A controlled prospective study. Diabetologia. 1990;33:244–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Ekman M. Economic evidence in stroke: a review. Eur J Health Econ. 2004;5 Suppl 1:S74–83.PubMedCrossRefGoogle Scholar
  49. 49.
    Truelsen T, Ekman M, Boysen G. Cost of stroke in Europe. Eur J Neurol. 2005;12 Suppl 1:78–84.PubMedCrossRefGoogle Scholar
  50. 50.
    Brown DL, Boden-Albala B, Langa KM, et al. Projected costs of ischemic stroke in the United States. Neurology. 2006;67:1390–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Stevens RJ, Coleman RL, Adler AI, et al. Risk factors for myocardial infarction case fatality and stroke case fatality in type 2 diabetes: UKPDS 66. Diabetes Care. 2004;27:201–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Lau J, Schmid CH, Chalmers TC. Cumulative meta-analysis of clinical trials builds evidence for exemplary medical care. J Clin Epidemiol. 1995;48:45–57. discussion 59–60.PubMedCrossRefGoogle Scholar
  53. 53.
    Pogue JM, Yusuf S. Cumulating evidence from randomized trials: utilizing sequential monitoring boundaries for cumulative meta-analysis. Control Clin Trials. 1997;18:580–93. discussion 661–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Stewart IM. Relation of reduction in pressure to first myocardial infarction in patients receiving treatment for severe hypertension. Lancet. 1979;1:861–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Fagard RH, Staessen JA, Thijs L, et al. On-treatment diastolic blood pressure and prognosis in systolic hypertension. Arch Intern Med. 2007;167:1884–91.PubMedCrossRefGoogle Scholar
  56. 56.
    Protogerou AD, Safar ME, Iaria P, et al. Diastolic blood pressure and mortality in the elderly with cardiovascular disease. Hypertension. 2007;50:172–80.PubMedCrossRefGoogle Scholar
  57. 57.
    McCloskey LW, Psaty BM, Koepsell TD, Aagaard GN. Level of blood pressure and risk of myocardial infarction among treated hypertensive patients. Arch Intern Med. 1992;152:513–20.PubMedCrossRefGoogle Scholar
  58. 58.
    Samuelsson OG, Wilhelmsen LW, Pennert KM, et al. The J-shaped relationship between coronary heart disease and achieved blood pressure level in treated hypertension: further analyses of 12 years of follow-up of treated hypertensives in the Primary Prevention Trial in Gothenburg, Sweden. J Hypertens. 1990;8:547–55.PubMedCrossRefGoogle Scholar
  59. 59.
    D'Agostino RB, Belanger AJ, Kannel WB, Cruickshank JM. Relation of low diastolic blood pressure to coronary heart disease death in presence of myocardial infarction: the Framingham Study. BMJ. 1991;303:385–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144:884–93.PubMedGoogle Scholar
  61. 61.
    Sleight P, Redon J, Verdecchia P, et al. Prognostic value of blood pressure in patients with high vascular risk in the ongoing telmisartan alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens. 2009;27:1360–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure. Lancet. 1987;1:581–4.PubMedCrossRefGoogle Scholar
  63. 63.
    Pastor-Barriuso R, Banegas JR, Damian J, et al. Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality. Ann Intern Med. 2003;139:731–9.PubMedGoogle Scholar
  64. 64.
    Boutitie F, Gueyffier F, Pocock S, et al. J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med. 2002;136:438–48.PubMedGoogle Scholar
  65. 65.
    Bakris GL, Gaxiola E, Messerli FH, et al. Clinical outcomes in the diabetes cohort of the International Verapamil SR-Trandolapril Study. Hypertension. 2004;44:637–42.PubMedCrossRefGoogle Scholar
  66. 66.
    Denardo SJ, Messerli FH, Gaxiola E, et al. Characteristics and outcomes of revascularized patients with hypertension: an international verapamil SR-trandolapril substudy. Hypertension. 2009;53:624–30.PubMedCrossRefGoogle Scholar
  67. 67.
    Bavry AA, Anderson RD, Gong Y, et al. Outcomes among hypertensive patients with concomitant peripheral and coronary artery disease: findings from the INternational VErapamil-SR/Trandolapril STudy. Hypertension. 2010;55:48–53.PubMedCrossRefGoogle Scholar
  68. 68.
    Haller H, Ito S, Izzo Jr JL, et al. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med. 2011;364:907–17.PubMedCrossRefGoogle Scholar
  69. 69.
    Chrysant SG, Chrysant GS. Effectiveness of lowering blood pressure to prevent stroke versus to prevent coronary events. Am J Cardiol. 2010;106:825–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Polese A, De Cesare N, Montorsi P, et al. Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle. Circulation. 1991;83:845–53.PubMedGoogle Scholar
  71. 71.
    Coope J, Warrender TS. Randomised trial of treatment of hypertension in elderly patients in primary care. Br Med J (Clin Res Ed). 1986;293:1145–51.CrossRefGoogle Scholar
  72. 72.
    Wilhelmsen L, Berglund G, Elmfeldt D, et al. Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial. J Hypertens. 1987;5:561–72.PubMedCrossRefGoogle Scholar
  73. 73.
    Psaty BM, Furberg CD, Kuller LH, et al. Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality: the cardiovascular health study. Arch Intern Med. 2001;161:1183–92.PubMedCrossRefGoogle Scholar
  74. 74.
    Glynn RJ, L'Italien GJ, Sesso HD, et al. Development of predictive models for long-term cardiovascular risk associated with systolic and diastolic blood pressure. Hypertension. 2002;39:105–10.PubMedCrossRefGoogle Scholar
  75. 75.
    Lubsen J, Wagener G, Kirwan BA, et al. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with symptomatic stable angina and hypertension: the ACTION trial. J Hypertens. 2005;23:641–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Langer RD, Criqui MH, Barrett-Connor EL, et al. Blood pressure change and survival after age 75. Hypertension. 1993;22:551–9.PubMedGoogle Scholar
  77. 77.
    Tervahauta M, Pekkanen J, Enlund H, Nissinen A. Change in blood pressure and 5-year risk of coronary heart disease among elderly men: the Finnish cohorts of the Seven Countries Study. J Hypertens. 1994;12:1183–9.PubMedCrossRefGoogle Scholar
  78. 78.
    Hakala SM, Tilvis RS. Determinants and significance of declining blood pressure in old age. A prospective birth cohort study. Eur Heart J. 1998;19:1872–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Arguedas JA, Perez MI, Wright JM. Treatment blood pressure targets for hypertension. Cochrane Database Syst Rev. 2009;CD004349.Google Scholar
  80. 80.
    Basile J, Black HR, Flack JM, Izzo Jr JL. The role of therapeutic inertia and the use of fixed-dose combination therapy in the management of hypertension. J Clin Hypertens. 2007;9:636–45.CrossRefGoogle Scholar
  81. 81.
    Bakris G, Hill M, Mancia G, et al. Achieving blood pressure goals globally: five core actions for health-care professionals. A worldwide call to action. J Hum Hypertens. 2008;22:63–70.PubMedCrossRefGoogle Scholar
  82. 82.
    National Heart Lung and Blood Institute. Systolic Blood Pressure Intervention Trial (SPRINT). Available at http://clinicaltrialsgov/ct2/show/NCT01206062.2011. Accessed on October 6, 2011.
  83. 83.
    Lv J, Perkovic V. Blood pressure management in diabetes: a path forward? J Hypertens. 2011;29:1283–4.PubMedCrossRefGoogle Scholar
  84. 84.
    Bangalore S, Kumar S, Lobach I, Messerli FH. Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and bayesian random-effects meta-analyses of randomized trials. Circulation. 2011;123:2799–810. 9 p following 810.PubMedCrossRefGoogle Scholar
  85. 85.
    Rutter MK, Nesto RW. Blood pressure, lipids and glucose in type 2 diabetes: how low should we go? Re-discovering personalized care. Eur Heart J. 2011;32:2247–55.PubMedCrossRefGoogle Scholar
  86. 86.
    Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ. 1998;316:823–8.PubMedCrossRefGoogle Scholar
  87. 87.
    Reboldi G, Gentile G, Angeli F, Verdecchia P. Exploring the optimal combination therapy in hypertensive patients with diabetes mellitus. Expert Rev Cardiovasc Ther. 2009;7:1349–61.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Gianpaolo Reboldi
    • 1
  • Giorgio Gentile
    • 1
  • Valeria Maria Manfreda
    • 2
  • Fabio Angeli
    • 3
  • Paolo Verdecchia
    • 4
  1. 1.Department of Internal MedicineUniversity of PerugiaPerugiaItaly
  2. 2.Nephrology and Dialysis Unit, Bolognini HospitalSeriateItaly
  3. 3.Division of Cardiology, Hospital S. Maria della MisericordiaPerugiaItaly
  4. 4.Division of Internal Medicine, Hospital of AssisiAssisiItaly

Personalised recommendations