Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis

Study Questions:

What is the effectiveness and safety of treating blood pressure (BP) to intensive targets (upper limit of 130 mm Hg systolic and 80 mm Hg diastolic) compared with standard targets in patients with type 2 diabetes mellitus?

Methods:

This was a meta-analysis of randomized trials of adults with type 2 diabetes mellitus and comparing prespecified BP targets. Included studies compared the impact of antihypertensive therapy to achieve prespecified intensive or standard BP targets on at least one endpoint of mortality, myocardial infarction, or stroke.

Results:

Treating BP to intensive targets was associated with a decrease in the risk for stroke (relative risk, 0.65; 95% confidence interval [CI], 0.48-0.86), but was not associated with a significant decrease in the risk for mortality (relative risk difference, 0.76; 95% CI, 0.55-1.05) or myocardial infarction (relative risk difference, 0.93; 95% CI, 0.80-1.08). In the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) study, the group treated to intensive targets had significantly higher rates (3.3% vs. 1.7%, p < 0.001) of any serious adverse event.

Conclusions:

Targeting BP management to intensive targets in patients with type 2 diabetes mellitus is associated with a small reduction in the risk for stroke without any reduction in the risk for mortality or myocardial infarction. One additional serious adverse event would be expected for every 60 patients treated to an intensive systolic target.

Perspective:

By examining the association between clearly defined BP targets and cardiovascular events, this meta-analysis builds on other studies that may not have classified treatment groups based on assignment of target BP. Limited by heterogeneity of included studies and sparse data, evidence from this meta-analysis would suggest that the value of intensive BP management may not lower the risk for mortality or myocardial infarction and offers only a small benefit in reducing the risk for stroke. The clinical benefit of aiming for intensive BP targets in patients with type 2 diabetes mellitus thus remains uncertain.

Clinical Topics: Heart Failure and Cardiomyopathies

Keywords: Renal Dialysis, Myocardial Infarction, Stroke, Cardiovascular Diseases, Risk Factors, Blood Pressure, Confidence Intervals, Diastole, Systole, Diabetes Mellitus


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