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Blood pressure targets in type 2 diabetes. Evidence against or in favour of an aggressive approach

Authors
  • Mancia, Giuseppe1,
  • Grassi, Guido2, 3
  • 1 University of Milano-Bicocca, Milano and Policlinico di Monza, Monza, Italy , Monza (Italy)
  • 2 University of Milano-Bicocca, Clinica Medica, Milan, Italy , Milan (Italy)
  • 3 Sesto San Giovanni, IRCCS Multimedica, Milan, Italy , Milan (Italy)
Type
Published Article
Journal
Diabetologia
Publisher
Springer-Verlag
Publication Date
Jan 25, 2018
Volume
61
Issue
3
Pages
517–525
Identifiers
DOI: 10.1007/s00125-017-4537-3
Source
Springer Nature
Keywords
License
Yellow

Abstract

When associated with high blood pressure, type 2 diabetes mellitus is characterised by a high risk of adverse cardiovascular (CV) and renal outcomes. However, both can be effectively reduced by antihypertensive treatment. Current guidelines on the treatment of hypertension emphasize the need to effectively treat high blood pressure in diabetic individuals, but their recommendations differ in terms of the optimal target blood pressure value to aim for in order to maximise CV and renal protection. In some guidelines the recommended target blood pressure values are <140/90 mmHg (systolic/diastolic), whereas in others, blood pressure values close or even less than 130/80 mmHg are recommended. This paper will discuss the evidence for and against a conservative or more aggressive blood pressure target for treated diabetic hypertensive individuals based on the evidence provided by randomised trials, trial meta-analyses and large observational studies. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90 mmHg, and that values approaching 130/80 mmHg should be recommended. However, evidence in favour of even lower systolic values, i.e. <130 mmHg, is limited and is definitively against a reduction to <120 mmHg.

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