People with type 2 diabetes are at a higher risk of heart attacks, strokes, heart failure, and death due to cardiovascular disease. A recent study conducted by researchers at UT Southwestern Medical Center and colleagues has found that maintaining a lower systolic blood pressure than current medical guidelines suggest could significantly reduce these risks.
The study, published in the New England Journal of Medicine, provides strong evidence for revising blood pressure targets for people with type 2 diabetes.
Dr. Jiang He, a senior author of the study and a professor at UT Southwestern, explained the importance of systolic blood pressure—the top number in a blood pressure reading. This number measures the pressure exerted on artery walls when the heart beats.
Current guidelines generally recommend a systolic blood pressure of less than 130 mm Hg for patients with diabetes, but there has been limited research to support this target. The new study, called the Blood Pressure Control Target in Diabetes trial, aimed to investigate whether an even lower target might improve cardiovascular health.
Study Design and Participants
The study included 12,821 participants, all with type 2 diabetes, elevated systolic blood pressure, and an increased risk of cardiovascular disease. Their average age was nearly 64, and about 45% were women. The participants were divided into two groups, each assigned a different blood pressure goal:
- A standard goal of less than 140 mm Hg.
- An intensive goal of less than 120 mm Hg.
Doctors used antihypertensive medications to help participants achieve these targets. Over five years, the researchers tracked blood pressure levels and the occurrence of major cardiovascular events, such as strokes, heart attacks, heart failure, and deaths caused by cardiovascular disease.
They also monitored adverse effects of the treatments, such as hypotension (abnormally low blood pressure) and hyperkalemia (excess potassium in the blood).
Results and Key Findings
Within a year, both groups achieved blood pressure readings close to their targets. The standard group averaged a systolic blood pressure of 133.2 mm Hg, while the intensive group averaged 121.6 mm Hg.
By the end of the study, the intensive treatment group showed a 21% reduction in major cardiovascular events compared to the standard group.
Specifically, the standard group experienced 492 events, mostly strokes, while the intensive group had 393 events.
This difference was statistically significant, highlighting the benefits of tighter blood pressure control. Although both groups had similar rates of serious side effects, the intensive group experienced more cases of hypotension and hyperkalemia.
Implications for Treatment
The study demonstrates that lowering systolic blood pressure to around 120 mm Hg can provide substantial cardiovascular benefits for patients with type 2 diabetes. While the more intensive treatment approach carried a slightly higher risk of side effects, these were generally manageable.
The findings suggest that more aggressive blood pressure management could help prevent heart attacks, strokes, and other serious cardiovascular issues in this high-risk population.
Dr. He emphasized that the results support updating clinical guidelines to recommend lower blood pressure targets for people with diabetes. By adopting a more intensive approach to blood pressure control, healthcare providers could significantly improve the long-term health and quality of life for millions of patients.
Conclusion
This research highlights the importance of rethinking current blood pressure guidelines for diabetes patients. Lowering systolic blood pressure to below 120 mm Hg not only reduces the risk of major cardiovascular events but also provides a clearer path for improving overall health in people with type 2 diabetes.
While further studies in broader populations could refine these recommendations, this study lays the groundwork for a significant shift in how doctors approach blood pressure management in diabetes care.
If you care about diabetes, please read studies about diabetes and vitamin B12, and the right diet for people with type 2 diabetes.
For more health information, please see recent studies about how to eat smart with diabetes, and turmeric and vitamin D: a duo for blood pressure control in diabetic patients.
The research findings can be found in the New England Journal of Medicine.
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