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)

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 

Clinical Trial Acronyms

ABCD

Appropriate Blood Pressure Control in Diabetes

ACCORD

Action to Control Cardiovascular Risk in Diabetes

HOT

Hypertension Optimal Treatment

INVEST

International Verapamil SR-Trandolapril Study

MRFIT

Multiple Risk Factor Intervention Trial

ONTARGET

Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

ROADMAP

Randomized Olmesartan and Diabetes Microalbuminuria Prevention

SPRINT

Systolic Blood Pressure Intervention Trial

UKPDS

UK Prospective Diabetes Study

Notes

Disclosure

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.

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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

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