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    Blood Pressure and Diabetes: How Low Should You Go?

    Study Suggests Guidelines Calling for Tight Control May Need a Second Look

    Moderate Control of Blood Pressure Wins Out

    During the follow-up, researchers looked to see which of the groups categorized by the amount of control were more likely to die from any cause or to have a heart attack or a stroke.

    Little difference was found between the tight control and moderate control groups. Of the 6,400:

    • 12.7% who had tight control died or had a heart attack or stroke.
    • 12.6% of those with moderate control did.
    • 19.8% of those with uncontrolled blood pressure did.

    During the extended follow-up period, the risk of death from any cause was actually higher in the tight control group, 22.8%, vs. those in the moderate control group, 21.8%.

    Cooper-DeHoff cautions that the results can't be generalized to those who have diabetes but not coronary artery disease.

    Even though the guidelines recommending lower blood pressures in those with diabetes have been in place for nearly 20 years, she writes, ''there is a paucity of evidence supporting this recommendation, particularly for lower systolic blood pressure."

    Cooper-DeHoff reports receiving research funds from Abbott Laboratories, which makes blood-pressure-lowering drugs.

    Second Opinion

    ''This is good news all the way around," says P.K. Shah, MD, a cardiologist and director of the division of cardiology at the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, who reviewed the study findings for WebMD.

    The take-home message for those like the participants, he says, is that moderate blood pressure control is a reasonable range to shoot for. "This is saying moderate control of blood pressure is effective."

    Other research finds that those with naturally low blood pressure are at reduced risk for problems such as heart attack and stroke, Shah says. "But drug-induced lowering [of blood pressure] is not the same as natural low blood pressure," he says, explaining that blood pressure lowering by drugs does not mimic all the good effects of having naturally low pressure.

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