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Blood pressure lowering in patients with diabetes—one level might not fit all

Nature Reviews Cardiology volume 8, pages 42–49 (2011)Cite this article

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Abstract

Hypertension and diabetes mellitus frequently occur together, leading to increased complications and mortality in patients with both these conditions. Blood pressure (BP) goals for patients with diabetes have consistently been more aggressive than for patients without diabetes. Although the benefits of lowering BP are well documented, data to support this more aggressive goal are lacking. In fact, lowering BP might not always be better. We review the available evidence regarding BP treatment in patients with hypertension and diabetes from randomized clinical trials, as well as available observational data. We also consider evidence related to the J-shaped curve, which reflects the relationship between BP and outcomes in patients with diabetes, and make recommendations for treatment of BP on the basis of a patient's individual risk, as opposed to on the basis of aggressive BP targets recommended by global guidelines. In the future, a personalized approach will maximize the benefits from treatment.

Key Points

  • Diabetes mellitus and hypertension are common comorbid conditions, and are associated with morbidity and mortality related to vascular disease

  • Blood pressure (BP) lowering is associated with reduction in cardiovascular-related morbidity and mortality

  • Current guidelines recommend a BP goal of <130/80 mmHg in patients with diabetes despite lack of evidence from clinical trials to support this goal

  • A J-shaped relationship exists between BP and cardiovascular risk, which seems to be most profound in patients with cardiovascular disease

  • Risk management in a patient with diabetes should include selection of a BP-lowering goal that is based on individual level of risk, together with an approach that focuses on the patient as a whole

  • Lowering BP to <140/90 mmHg in all patients, regardless of diabetes status, is warranted on the basis of current evidence

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Figure 1: Systolic and diastolic BP treatment goals for patients with diabetes.

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Author information

Authors and Affiliations

  1. Department of Pharmacotherapy and Translational Research, College of Pharmacy, P. O. Box 100486, University of Florida, Gainesville, 32610-0486, FL, USA

    Rhonda M. Cooper-DeHoff & Eric F. Egelund

  2. Division of Cardiovascular Medicine, College of Medicine, P. O. Box 100277, University of Florida, Gainesville, 32610-0277, FL, USA

    Carl J. Pepine

Authors
  1. Rhonda M. Cooper-DeHoff
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  2. Eric F. Egelund
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  3. Carl J. Pepine
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Contributions

R. M. Cooper-DeHoff contributed to discussion of content for the article, researched data to include in the manuscript, wrote the article, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments. E. F. Egelund researched data to include in the manuscript and wrote the article. C. J. Pepine contributed to discussion of content for the article and reviewed and edited the manuscript before submission.

Corresponding author

Correspondence to Rhonda M. Cooper-DeHoff.

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Competing interests

C. J. Pepine has received grants from AstraZeneca, AtCor Medical, Baxter, Bioheart, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Pfizer, Sanofi-Aventis, and Schering-Plough. He is a consultant for Abbott Laboratories, Angioblast Systems, Forest Laboratories, Medtelligence, NicOx, Novartis, Sanofi-Aventis, and SLACK Incorporated. R. M. Cooper-DeHoff and E. F. Egelund declare no competing interests.

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Cooper-DeHoff, R., Egelund, E. & Pepine, C. Blood pressure lowering in patients with diabetes—one level might not fit all. Nat Rev Cardiol 8, 42–49 (2011). https://doi.org/10.1038/nrcardio.2010.182

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