A new study on blood pressure control in patients with type 2 diabetes has revealed significant findings that could change the way doctors treat blood pressure in these patients. The study, conducted in China, involved more than 12,000 participants aged 50 or older who had type 2 diabetes and an increased risk of cardiovascular disease. This risk was defined by factors like prior cardiovascular events, multiple risk factors, or a reduced kidney function (eGFR).
The study aimed to answer a crucial question: what is the ideal blood pressure target for patients with type 2 diabetes? While previous research, such as the ACCORD trial, investigated this issue, it didn’t show clear benefits in blood pressure reduction for all patients. However, certain groups did show positive outcomes, making the findings inconclusive. The new study, however, offers more definitive results.
The research focused on systolic blood pressure, setting a target of less than 120 mm Hg for the intensively treated group, and less than 140 mm Hg for the standard treatment group. The primary goal was to prevent major cardiovascular events, such as nonfatal strokes, heart attacks, heart failure hospitalizations, and death from cardiovascular causes.
Key study details include:
- 45% of participants were women.
- The average age was 63.8 years, with a body mass index (BMI) of 26.7.
- 25% of participants were smokers.
- The baseline blood pressure was 140/76 mm Hg.
- Over four years, the mean systolic blood pressure was 121.6 mm Hg in the intensive treatment group and 133.2 mm Hg in the standard treatment group.
After about a year, the two groups started to show a noticeable difference in the primary outcomes. By the end of the study, the intensive treatment group had significantly better results compared to the standard treatment group.
For the researchers, the blood pressure targets achieved were fairly standard. The intensive group averaged around 120 mm Hg, while the standard group had a target of 130 mm Hg.
The findings have influenced some healthcare professionals to consider lowering their blood pressure treatment targets for patients with type 2 diabetes. One physician noted that this study has motivated them to aim for lower systolic targets in their practice, believing it could offer further benefits for patients.
To ensure accurate measurements, the study took extra steps to reduce “white coat hypertension,” a condition where blood pressure is temporarily high due to stress during a medical visit. Participants were instructed to avoid exercise, coffee, and cigarettes for at least 30 minutes before their appointment. Blood pressure was then measured after five minutes of seated rest, with three readings taken one minute apart.
Treatment regimens followed standard hypertension guidelines, with participants in the intensive group requiring one or two additional medications compared to the standard group. While the overall rate of severe adverse events was similar in both groups, the intensive group experienced more cases of symptomatic hypotension and high potassium levels.
Ultimately, the study highlights that even small differences in systolic blood pressure—such as the gap between 120 mm Hg and 133 mm Hg—can have a meaningful impact on cardiovascular outcomes. For patients who can tolerate lower blood pressure without symptoms like dizziness, doctors may now aim for a lower target, potentially improving long-term health outcomes.
This well-executed study is expected to influence both clinical practice and future treatment guidelines for managing blood pressure in type 2 diabetes. It offers valuable insights into what may be the optimal target for these patients’ blood pressure control.
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