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Blood Pressure Targets and Type 2 Diabetes

Reevaluating the Evidence for Blood Pressure Targets in Type 2 Diabetes

  1. Julio A. Lamprea-Montealegre1,2 and
  2. Ian H. de Boer1,3,4⇑
  1. 1Kidney Research Institute, University of Washington, Seattle, WA
  2. 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA
  3. 3Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
  4. 4Department of Epidemiology, University of Washington, Seattle, WA
  1. Corresponding author: Ian H. de Boer, deboer{at}uw.edu.
Diabetes Care 2018 Jun; 41(6): 1132-1133. https://doi.org/10.2337/dci17-0063
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There is general consensus that treating adults with type 2 diabetes mellitus (T2DM) and hypertension to a target blood pressure (BP) of <140/90 mmHg helps prevent cardiovascular disease (CVD). Whether more intensive BP control should be routinely targeted remains a matter of debate. While the American Diabetes Association (ADA) BP guidelines recommend an individualized assessment to consider different treatment goals, the American College of Cardiology/American Heart Association BP guidelines recommend a BP target of <130/80 mmHg for most individuals with hypertension, including those with T2DM (1–3).

In large part, these discrepant recommendations reflect the divergent results of the Action to Control Cardiovascular Risk in Diabetes-BP trial (ACCORD-BP) among people with T2DM and the Systolic Blood Pressure Intervention Trial (SPRINT), which excluded people with diabetes (4,5). Both trials evaluated the effect of intensive compared with standard BP treatment targets (<120 vs. <140 mmHg systolic) on a composite CVD end point of nonfatal myocardial infarction or stroke or death from cardiovascular causes. SPRINT also included unstable angina and acute heart failure in its composite end point. While ACCORD-BP did not show a significant benefit from the intervention (hazard ratio [HR] 0.88; 95% CI 0.73–1.06), SPRINT found a significant 25% relative risk reduction on the primary end point favoring intensive therapy (0.75; 0.64–0.89).

Why did ACCORD-BP and SPRINT arrive at divergent conclusions? Recent secondary analyses provide new insights into potential reasons, including differences in trial design, populations studied, approach to BP lowering, trial end points, and statistical power or chance findings.

While SPRINT used a parallel group study design, ACCORD-BP used …

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Diabetes Care: 41 (6)

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June 2018, 41(6)
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Reevaluating the Evidence for Blood Pressure Targets in Type 2 Diabetes
Julio A. Lamprea-Montealegre, Ian H. de Boer
Diabetes Care Jun 2018, 41 (6) 1132-1133; DOI: 10.2337/dci17-0063

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Reevaluating the Evidence for Blood Pressure Targets in Type 2 Diabetes
Julio A. Lamprea-Montealegre, Ian H. de Boer
Diabetes Care Jun 2018, 41 (6) 1132-1133; DOI: 10.2337/dci17-0063
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  • Comment on Bress et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017;40:1401–1408
  • Response to Comment on Bress et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017;40:1401–1408
  • Effect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Population-Based Retrospective Cohort Study
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