Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus
Open Access
- 24 September 2012
- journal article
- review article
- Published by American Medical Association (AMA) in Archives of Internal Medicine
- Vol. 172 (17), 1296-1303
- https://doi.org/10.1001/archinternmed.2012.3147
Abstract
Background Treatment of hypertension in patients with diabetes mellitus (DM) has been shown to improve cardiovascular outcomes; however, the value of intensive blood pressure (BP) targets remains uncertain. We sought to determine the effectiveness and safety of treating BP to intensive targets (upper limit of 130 mm Hg systolic and 80 mm Hg diastolic) compared with standard targets (upper limit of 140-160 mm Hg systolic and 85-100 mm Hg diastolic) in patients with type 2 DM. Methods Using electronic databases, bibliographies, and clinical trial registries, we conducted a systematic review and meta-analysis to identify randomized trials enrolling adults diagnosed as having type 2 DM and comparing prespecified BP targets. Data on study characteristics, risk for bias, and outcomes were collected. Random-effects models were used to pool relative risks and risk differences for mortality, myocardial infarction, and stroke. Results The use of intensive BP targets was not associated with a significant decrease in the risk for mortality (relative risk difference, 0.76; 95% CI, 0.55-1.05) or myocardial infarction (relative risk difference, 0.93; 95% CI, 0.80-1.08) but was associated with a decrease in the risk for stroke (relative risk, 0.65; 95% CI, 0.48-0.86). The pooled analysis of risk differences associated with the use of intensive BP targets demonstrated a small absolute decrease in the risk for stroke (absolute risk difference, −0.01; 95% CI, −0.02 to −0.00) but no statistically significant difference in the risk for mortality or myocardial infarction. Conclusion Although the use of intensive compared with standard BP targets in patients with type 2 DM is associated with a small reduction in the risk for stroke, evidence does not show that intensive targets reduce the risk for mortality or myocardial infarction.Keywords
This publication has 22 references indexed in Scilit:
- Effects of intensive blood pressure reduction on myocardial infarction and stroke in diabetes: a meta-analysis in 73 913 patientsJournal of Hypertension, 2011
- Interpretation of random effects meta-analysesBMJ, 2011
- Effects of Intensive Blood-Pressure Control in Type 2 Diabetes MellitusThe New England Journal of Medicine, 2010
- Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trialThe Lancet, 2007
- Prediction of Lifetime Risk for Cardiovascular Disease by Risk Factor Burden at 50 Years of AgeCirculation, 2006
- Comparison of Two Methods to Detect Publication Bias in Meta-analysisJama-Journal Of The American Medical Association, 2006
- A modified test for small‐study effects in meta‐analyses of controlled trials with binary endpointsStatistics in Medicine, 2005
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003
- Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokesKidney International, 2002
- Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic HypertensionThe New England Journal of Medicine, 1999