Untreated hypertension fuels the risk for cardiovascular issues, including heart attacks and strokes, while diabetes drives cardiovascular risk independently of high blood pressure. The simultaneous occurrence of hypertension and diabetes dramatically magnifies a person’s risk for cardiovascular disease. People with type 2 diabetes who received intensive treatment to keep their blood pressure levels at 130/80 mm/Hg or below had fewer heart attacks, strokes and other diabetes complications, according to a study published in the journal Hypertension. These patients also had lower overall risk of dying from any cause–a benefit that was observed regardless of a person’s preexisting cardiovascular risk and baseline blood pressure, the research shows. The findings shed new light on optimal blood-pressure targets and could help reconcile conflicting guidelines for the treatment for hypertension in people with type 2 diabetes– affecting more than 420 million people worldwide. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines called for beginning anti-hypertensive treatment at a blood pressure of 130/80 mmHg or higher for adults with diabetes and hypertension.
The study results suggest that aiming for blood pressure levels of 130/80 mm/Hg or lower can benefit patients at various degrees of baseline blood pressure elevation and with different cardiovascular risk — a composite score that estimates a person’s likelihood of having a heart attack or stroke within 10 years. The new study findings are based on analysis of outcomes among nearly 11,000 patients with type 2 diabetes followed over 4 years across 215 clinical centers in 20 countries as part of the international study ADVANCE. The researchers compared outcomes between moderate to high cardiovascular risk people with type 2 diabetes and hypertension, receiving anti-hypertension combination (perindopril and indapamide) and people with diabetes and hypertension receiving placebo. This trial had already reported benefit overall for the additional hypertension treatment, however, it was not known whether this benefit also applied to people with diabetes who started off with a blood pressure below 140/90 mmHg, To determine treatment benefit, the analysis compared rates of overall death from any cause as well as the rate of major vascular events, including heart attacks, strokes, diabetes-related kidney disease and diabetes-related eye damage.
Both patients at higher baseline risk for cardiovascular disease and those with lower cardiovascular risk benefitted from the more intensive treatment. In addition, those with diabetes and with blood pressures in the 130/80 mmHg to 140/90 mmHg range before starting the trial benefited from more intensive therapy, achieving lower blood pressures during the trial. During the study, there were 837 deaths and 966 major vascular events like heart attacks, strokes, diabetic kidney disease or retinopathy. The group receiving intensive blood pressure therapy experienced 9% fewer events and 14% fewer deaths than the group taking placebo. Senior investigator J. Bill McEvoy, professor of preventive Cardiology at the National University of Ireland, Galway Campus, and the Irish National Institute for Preventive Cardiology, explained: “Our findings demonstrate a benefit of more intensive therapy aiming for blood pressure thresholds at 130/80 or below and should help resolve some ongoing confusion over optimal blood pressure targets for people with diabetes. Patients, including those with diabetes, with blood pressure levels above 130/80 on two consecutive checks should discuss with their physicians whether they need change in treatment to get to a lower number”.
After all, early prevention is the target of every Sanitary Service to cut down the huge medical costs linked to diabetes.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Rahman F et al. ADVANCE Collab Group. Hypertension 2019 Apr 29.
Ohara M et al., Hirano T. Diabetol Metab Syndr. 2019 Apr 11;11:29.
Rahman F, McEvoy JW. Curr Cardiol Rep. 2018 Sep 26; 20(11):108.