What Blood Pressure Goal in Type-2 Diabetes?
Journal für Hypertonie - Austrian Journal of Hypertension 2011; 15 (4): 9-14
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Keywords: Blutdruck, Diabetes mellitus Typ 2, Hypertonie, Leitlinie, Metaanalyse, blood pressure, Guideline, hypertension, meta-analysis
Hypertension in diabetes is a wellknown risk factor for cardiovascular diseases that should be taken seriously. Observational studies have shown a more or less linear relationship between systolic blood pressure levels and risk, but this does not correspond with the outcome results of intervention trials to lower blood pressure. In fact, tight blood pressure control has only been shown to be of general benefit in the range of 130–135 mmHg systolic blood pressure, but not below except for stroke prevention. On the other hand, there might even exist an increased risk for coronary heart disease events and cardiovascular mortality at lower ranges based on data from observational studies. This fact, in combination with the increased costs and risk of serious adverse events, cautions clinicians not to lower systolic blood pressure too much in susceptible patients with longer diabetes duration, more comorbidities, and in older age groups. However, we should not lose sight of the challenge that still around half of all patients with type-2 diabetes are not even below the desired minimum goal of 140 mmHg systolic blood pressure. This calls for improved actions to control blood pressure as part of a general strategy to counteract all cardiovascular risk factors in patients with type-2 diabetes. The higher the risk, the more ambitious should be the approach to screen, detect, treat, and monitor these risk factors.