Blood Pressure–Related Outcomes in a Diabetic Population
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See related article, pp 71–77
There has been significant controversy during the past decade about what is appropriate blood pressure control to optimally reduce cardiovascular disease– (CVD) and kidney disease–related events in patients with diabetes mellitus. The recent discussion on blood pressure targets in diabetes mellitus sets the stage for a thought-provoking contribution by Wu et al1 who reported that individuals with diabetes mellitus with persistently low pressures <120/80 mm Hg or pressures that drop below 120/80 mm Hg have an increase in CVD events and mortality over time.
On the basis of data derived from larger clinical trials in those with diabetes mellitus, the seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure advised a 130/80 mm Hg target.2 However, achieved systolic blood pressures in those trials were rarely below 130/80 mm Hg and limited to only a few studies.3,4 The Action of Control Cardiovascular Risk in Diabetes (ACCORD) trial was then designed to investigate whether targeting pressures in patients with diabetes down to 120/80 mm Hg would improve CVD outcomes to a greater extent than a goal of <140/90 mm Hg. At end of trial, the overall CVD results were null, but stroke was reduced in those with achieved pressures of <120/80 mm Hg.5 Another recent trial, the Systolic Blood Pressure Intervention Trial (SPRINT), was designed to investigate whether pressures <120/80 mm Hg would improve outcomes in patients with kidney disease compared with 140/90 mm Hg. The SPRINT investigators reported an improvement in fatal and nonfatal major CVD events in the intensive arm <120/80 mm Hg.6 Although …