Many people with diabetes also have high blood pressure. Clinical guidelines have suggested blood pressure levels in people with diabetes should be kept lower than the standard for people without diabetes. However, a new review from The Cochrane Library does not find support for this practice.
"It's been clinical practice to try to decrease blood pressure as much as possible in this group in order to reduce both mortality and morbidity," said Jose Agustin Arguedas, M.D., professor in the department of clinical pharmacology at the University of Costa Rica. Several frequently used clinical guidelines suggest that people with diabetes should have blood pressure less than 130 over 80, he said.
Lowering blood pressure typically means increasing the number or dosage of medications, which can be inconvenient and expensive for patients.
In the new review, the researchers studied five trials with a total of 7,314 participants to evaluate whether lower blood pressure targets (less than 130/85 mmHg) for people with diabetes were better than standard blood pressure targets. The review determined that setting blood pressure targets lower than 140 over 90 mmHg in people with diabetes did not lower the risk of heart attack, stroke or death.
"From a diabetes perspective, people with type 2 diabetes have issues other than just blood sugar that determines ultimate risk for complications," said John E. Anderson, M.D. president for science and medicine at the American Diabetes Association. "Patients with diabetes have increased risk of cardiovascular problems like stroke and heart attack and so treatment for blood sugar, blood pressure and cholesterol are of paramount importance. This Cochrane review correlates and conforms to our standards of care at ADA—that we should treat to target a goal of 140 over 80 or less."
For some populations, he said, even more aggressive blood pressure targeting might be appropriate if it can be done without undue burden of medication.
"Surprisingly perhaps, most people assumed it was a recognized fact that we should try to get blood pressure [as low as possible] in this population and therefore additional research wasn't needed," noted Arguedas. "We showed we need more research to really answer the question about how to treat high blood pressure in order to achieve the greatest benefit and the lowest risk for this population."
Graham
This might explain why aggressive BP goals are less than helpful to diabetics:
ReplyDeletehttp://healthydietsandscience.blogspot.co.nz/2013/11/statins-fibrates-and-beta-blockers.html
Low-carb is going to adjust BP, adequate protein, omega 3/6 ratio, and consideration of electrolytes and antioxidants (as per DASH 2 results) are other ways in which to move safely.
Drugs, not so much.
Low carb does or can help to adjust BP. Other outside influences i.e. not smoking, moderate or low alcohol intake may possibly help. If you can avoid drugs, not always possible, it must be better in the long run.
ReplyDeleteMartin
This doesn't really surprise me.
ReplyDeleteMaybe one day they will begin to think of diabetes treatment holistically instead of as a collection of symptoms to be dealt with separately.
Thanks for the link ,George.
Kath
Well, I really like your blog. Yes, you are right. Aggressive blood pressure can make situation more worse for a diabetic person. It is really necessary to
ReplyDelete