The ideal blood pressure target to prevent cardiovascular disease in type 2 diabetes: a neutral viewpoint.

S Frontoni, A Solini, P Fioretto, A Natali, A Zuccalà, F Cosentino, G Penno

Journal: Nutrition, metabolism, and cardiovascular diseases : NMCD 2015;24(6):577-84

PMID: 24582686

Full Text on Elsevier Science View on PubMed

Abstract

Type 2 diabetes mellitus (T2DM) and essential hypertension are often associated, and retrospective data analyses suggest an association between lower blood pressure (BP) values and lower cardiovascular (CV) risk in patients with T2DM. However, the most recent intervention trials fail to demonstrate a further CV risk reduction, for BP levels <130/80 mm Hg, when compared to levels <140/90 mm Hg. Moreover, a J-shaped, rather than a linear, relationship of BP reduction with incident CV events has been strongly suggested. We here debate the main available evidences for and against the concept of 'the lower the better', in the light of the main intervention trials and meta-analyses, with a particular emphasis on the targets to be pursued in elderly patients. Finally, the most recent guidelines of the scientific societies are critically discussed.

Address: Department of Systems Medicine, University of Rome Tor Vergata - AFAR, Fatebenefratelli Hospital, Rome, Italy. Electronic address: [email protected].; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.; Department of Medicine, University of Padova, Padova, Italy.; Nephrology Dialysis Unit, Civil Hospital Imola, Imola, Italy.; Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy.; Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Disease, University of Pisa, Pisa, Italy.

DOI: 10.1016/j.numecd.2014.01.004

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MeSH Terms: Age Factors, Aged, Aged, 80 and over, Antihypertensive Agents, Biomarkers, Blood Pressure, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diabetic Cardiomyopathies, Drug Monitoring, Evidence-Based Medicine, Humans, Hypertension, International Agencies, Middle Aged, Practice Guidelines as Topic, Precision Medicine, Risk Factors, Societies, Medical, Societies, Scientific, Voluntary Health Agencies