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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
By
WebMD Health News
Reviewed by Louise Chang, MD

July 6, 2010 -- Tight control of high blood pressure, recommended for those with diabetes by national guidelines, gives no better results than moderate control, according to a new study.

''The guidelines suggest you want diabetics to have [systolic pressure] under 130," says researcher Rhonda M. Cooper-DeHoff, PharmD, associate professor of pharmacy and medicine at the University of Florida, Gainesville.

But in her study, those who kept their systolic pressures moderately controlled -- at 130 to 139 -- did as well as those who controlled it more tightly. Systolic pressure is the upper of the two blood pressure numbers, representing the maximum pressure exerted when the heart contracts.

She compared ranges of blood pressure control on the effect on death, heart attack, and stroke during the follow-up. "There was no difference comparing those with tight control or usual control," she tells WebMD, "which is contrary to what the guidelines would suggest."

''The message is: we need to get diabetic patients' systolic blood pressure to less than 140, particularly when they have heart disease, but working to get it to less than 130 does not appear to add any additional benefit with regard to the risk of death, stroke, or heart attack," Cooper-DeHoff says.

The study is published in the Journal of the American Medical Association.

Tight Control of Blood Pressure vs. Moderate Control

For this study, Cooper-DeHoff and colleagues looked at a subgroup of 6,400 participants of a large study, called INVEST (International Verapamil SR-Trandolapril Study). It included more than 22,000 participants from 14 countries who were at least 50 years old and had high blood pressure and coronary artery disease.

Study participants enrolled in the study from 1997 to 2000 and were followed through March 2003, with follow-up for U.S. participants extended through August 2008.

For this analysis, the researchers focused only on the 6,400 who also had diabetes at the study start.

INVEST compared two blood pressure lowering approaches, with participants given either a calcium antagonist medication first or a beta-blocker medication, followed by more drugs if needed to lower pressure.

Next, the researchers categorized the 6,400 participants into three groups:

  • 35.2% had tight control, with systolic pressure maintained at below 130.
  • 30.8% had moderate or usual control, with pressures from 130 to under 140.
  • 34% had uncontrolled, with pressures above 140.

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