Post Tease Icon

Note on Healthcare

Picking a blood pressure target

Blood pressure (BP) control in people with diabetes is more important and has more impact than glycemic control. About 80% of people with type 2 diabetes have hypertension, and over 50% have a BP above target. But what should the target be? The ACCORD trial looked at people with diabetes who had an increased cardiovascular risk, and concluded that a BP target of < 120 mm Hg was associated with more side effects and no benefits compared to a BP < 140 mm Hg. More recently the SPRINT trial, which also included people at increased cardiovascular risk but EXCLUDED people with diabetes, showed a benefit for BP < 120 mm Hg. This study released today in the American Journal of Medicine offers a nice meta-analysis of 17 large-scale trials, and concluded that a BP < 130 mm Hg offered the best balance of benefit and safety.

I think that < 130 mm Hg is a good overall goal for people with diabetes, with a caveat against over-treatment. The first anti-hypertensive agent brings the most benefit. Adding a third or fourth agent can increase side effects, costs and inconvenience while providing minimal additional benefit. Remember that exercise and relaxation therapies can also help.

See abstract here

Share this on Twitter

You might also like

Off the beaten path Psychosocial

You don’t know me

This moving essay from primary care doctor Kate Rowland exposes the disconnection between many dying individuals and their real, non-critically ill identities. This disconnection, since it occurs at the end of life and will remain our most recent mem...

Read More
See more posts