Abstract
The goal of treating hypertension in patients with diabetes is reduction of macrovascular and microvascular complications. Most current guidelines recommend more aggressive treatment goals with blood pressure (BP) targets of < 130/80 mmHg. Retrospective data analyses suggest an association between a lower BP and slower declines in chronic kidney disease (CKD) as well as greater cardiovascular (CV) risk reduction in patients with type 2 diabetes. Such recommendations, however, are not supported by appropriately powered prospective outcome trials. Indeed, several important questions regarding aggressive lowering of BP levels are still unanswered. Major limitations of most existing clinical trials of BP lowering in diabetes is the failure to either target or achieve mean systolic BP values below 130 mmHg. Data from more recent randomized trials that evaluated different levels of BP do not support a BP below 130/80 mmHg as providing further CV risk reduction and compared to levels below 140/90 mmHg. One consistent benefit of a lower BP level, however, is on reduction of cerebrovascular events. There is reasonable evidence that a lower BP level does further slow progression of advanced proteinuric kidney disease such that a BP goal < 130/80 mmHg is defensible. This review examines the data for and against aggressive BP lowering in patients with diabetes.
Keywords: Diabetes mellitus, blood pressure, aggressive treatment, chronic kidney disease, cardiovascular risk, hypertension, myocardial infarction, impaired fasting glucose, hazard ratio, atherosclerosis
Current Vascular Pharmacology
Title: Pros and Cons of Aggressive Blood Pressure Lowering in Patients with Type 2 Diabetes
Volume: 10 Issue: 2
Author(s): Rigas G. Kalaitzidis and George L. Bakris
Affiliation:
Keywords: Diabetes mellitus, blood pressure, aggressive treatment, chronic kidney disease, cardiovascular risk, hypertension, myocardial infarction, impaired fasting glucose, hazard ratio, atherosclerosis
Abstract: The goal of treating hypertension in patients with diabetes is reduction of macrovascular and microvascular complications. Most current guidelines recommend more aggressive treatment goals with blood pressure (BP) targets of < 130/80 mmHg. Retrospective data analyses suggest an association between a lower BP and slower declines in chronic kidney disease (CKD) as well as greater cardiovascular (CV) risk reduction in patients with type 2 diabetes. Such recommendations, however, are not supported by appropriately powered prospective outcome trials. Indeed, several important questions regarding aggressive lowering of BP levels are still unanswered. Major limitations of most existing clinical trials of BP lowering in diabetes is the failure to either target or achieve mean systolic BP values below 130 mmHg. Data from more recent randomized trials that evaluated different levels of BP do not support a BP below 130/80 mmHg as providing further CV risk reduction and compared to levels below 140/90 mmHg. One consistent benefit of a lower BP level, however, is on reduction of cerebrovascular events. There is reasonable evidence that a lower BP level does further slow progression of advanced proteinuric kidney disease such that a BP goal < 130/80 mmHg is defensible. This review examines the data for and against aggressive BP lowering in patients with diabetes.
Export Options
About this article
Cite this article as:
G. Kalaitzidis Rigas and L. Bakris George, Pros and Cons of Aggressive Blood Pressure Lowering in Patients with Type 2 Diabetes, Current Vascular Pharmacology 2012; 10 (2) . https://dx.doi.org/10.2174/157016112799304996
DOI https://dx.doi.org/10.2174/157016112799304996 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
Call for Papers in Thematic Issues
Advancements in Arterial Stiffness: Novel Therapeutic Frontiers
Arterial stiffness, a hallmark of cardiovascular disease, poses significant challenges in contemporary healthcare. This thematic issue delves into the multifaceted landscape of arterial stiffness and explores cutting-edge therapeutic interventions aimed at mitigating its adverse effects. Within these pages, readers will find a comprehensive overview of the mechanisms underlying arterial stiffness, ...read more
Ischemic Cardiovascular Diseases: Mechanisms, Diagnosis and Therapy
Ischemic cardiovascular disease includes myocardial infarction, coronary atherosclerotic heart disease, angina pectoris, etc., constitute the leading cause of patient mortality by preventing tissues from getting sufficient oxygen and nutrients. Ischemic heart disease, as a clinical condition, is characterized by myocardial ischemia, causing an imbalance between myocardial blood supply and demand, ...read more
TREATMENT OF CARDIOVASCULAR DISEASE IN CHRONIC AND END STAGE KIDNEY DISEASE
Cardiovascular disease still remains the leading cause of death in Chronic and End Stage Kidney Disease, accounting for more than half of all deaths in dialysis patients. During the past decade, research has been focused on novel therapeutic agents that might delay or even reverse cardiovascular disease and vascular calcification, ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Nitric Oxide, Peroxynitrite, Peroxynitrous Acid, Nitroxyl, Nitrogen Dioxide, Nitrous Oxide: Biochemical Mechanisms and Bioaction
Current Bioactive Compounds Asymmetric Dimethylarginine (ADMA): A Promising Biomarker for Cardiovascular Disease?
Current Topics in Medicinal Chemistry Cellular Mechanisms of Bypass Vein Graft Arterialization and Approaches to Attenuate Graft Remodeling
Vascular Disease Prevention (Discontinued) The Effects of Hemocoagulase on Coagulation Factors in an Elderly Patient with Upper Gastrointestinal Hemorrhage: A Case Report
Current Drug Safety Impact of Telaprevir in HCV Patients with Cirrhosis and RVR: Real-Life Data from Boceprevir or Telaprevir based “Triple Therapy” Experience in Southern Italy
Reviews on Recent Clinical Trials Mitochondria-Associated Membranes (MAMs): A Novel Therapeutic Target for Treating Metabolic Syndrome
Current Medicinal Chemistry Clinical Pharmacology of Frequently Used Intravenous Drugs During Bariatric Surgery in Adolescents
Current Pharmaceutical Design Alterations in Plasma Triglyceride Concentrations Following Two Oral Meals with Different Fat Content in Patients with Type 2 Diabetes Mellitus
Current Vascular Pharmacology Effectiveness of Long-Term Macrolide Therapy in Cryptogenic Organising Pneumonia
Current Respiratory Medicine Reviews Pre-CKD- Do we Need Another Hero?
Current Vascular Pharmacology Microdialysis in Neurointensive Care
Current Pharmaceutical Design Management of Blood Pressure and Heart Rate in Patients with Acute Stroke
Current Pharmaceutical Design The Influence of Microneedles on the Percutaneous Penetration of Selected Antihypertensive Agents: Diltiazem Hydrochloride and Perindopril Erbumine
Current Drug Delivery Endotoxin, Toll-like Receptor-4, and Atherosclerotic Heart Disease
Current Cardiology Reviews Meet Our Co-Editor
Cardiovascular & Hematological Agents in Medicinal Chemistry Opportunities to Discover Genes Regulating Depression and Antidepressant Response from Rodent Behavioral Genetics
Current Pharmaceutical Design Importance of Pharmacology Knowledge by Dieticians
Current Nutrition & Food Science DL-3-n-Butylphthalide, an Anti-Oxidant Agent, Prevents Neurological Deficits and Cerebral Injury Following Stroke per Functional Analysis, Magnetic Resonance Imaging and Histological Assessment
Current Neurovascular Research Adverse Effects of Tacrolimus in Renal Transplant Patients from Living Donors
Current Drug Safety Gene Therapy for Cardiovascular Diseases
Current Pharmaceutical Design