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Aggressive antihypertensive treatment may cause harm in people with diabetes
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People with diabetes and systolic blood pressure levels less than 140 mm Hg have an increased risk for death from cardiovascular causes when they are assigned antihypertensive drugs, according to study results.
“At the same time, it is important to remember that [BP]-lowering treatment is crucial for the majority of people with diabetes whose [BP] measures above 140 [mm Hg],” Mattias Brunström, a PhD student in the department of public health and clinical medicine at Umeå University in Sweden, said in a press release.
Brunström and Bo Carlberg, MD, PhD, associate professor at Umeå University, evaluated 49 randomized controlled trials to determine the effect of antihypertensive treatment on mortality and CV morbidity in people with diabetes at different BP levels.
Researchers found a reduction in all-cause mortality when before-treatment systolic BP levels were higher than 140 mm Hg and when BP reached 130 mm Hg to 140 mm Hg with treatment. There was a small increased risk for all-cause mortality when baseline systolic BP was less than 140 mm Hg; however, this was not significant.
There was a reduction in CV mortality when baseline systolic BP was higher than 150 mm Hg; however, the risk was increased by 15% when baseline systolic BP was less than 140 mm Hg (RR = 1.15; 95% CI, 1-1.32).
“In practice, it is important to remember that undertreatment of high [BP] is a bigger problem than overtreatment,” Brunström said in the release. “Many treatment guidelines, both Swedish and international, will be redrawn in the next few years. It has been discussed to recommend even lower [BP] levels for people with diabetes — maybe as low as 130 [mm Hg]. We are hoping that our study, which shows potential risks of such aggressive [BP]-lowering treatment, will come to influence these guidelines.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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