Are blood pressure goals for diabetics too tough?
Aggressively controlling blood pressure in diabetics with heart disease may do little to reduce their risks of dying early and may even be dangerous, U.S. researchers said on Tuesday.
They found that using a combination of drugs to keep diabetic patients’ top blood pressure readings below 130 offered no benefit over those whose top reading was below 140 – the cutoff point for high blood pressure.
Normal blood pressure for healthy people is considered to be 120/80 or lower.
“Clearly, patients and doctors work very hard to get diabetic patients’ blood pressure to less than 130. Our data would suggest maybe we can stop at two drugs instead of three. And maybe we can spend a little more time talking about diet and exercise and cholesterol,” Rhonda Cooper-DeHoff of the University of Florida and colleagues wrote in the Journal of the American Medical Association.
The study is the latest to look at whether treating diabetics aggressively with drugs to control their risk of a heart attack or stroke has any benefit. Several teams have found it in fact can be dangerous for some patients.
A five-year, U.S. government-backed study dubbed ACCORD was stopped temporarily in February 2008 because 20 percent more diabetics with heart problems who got intensive treatment to lower their blood sugar died compared to those treated more conservatively.
The patients getting the tougher treatment were transferred into the gentler group and the trial continued. The latest long-term results, reported at the American Diabetes Association meeting last week, showed using more drugs to control blood pressure did little to prevent heart problems.
Cooper-DeHoff said most of the patients in the ACCORD trial did not have heart disease. Her team looked specifically at 6,400 diabetics with heart disease taking part in an international trial that examined different combinations of several common drug treatments to control blood pressure – diuretics, calcium channel blockers and ACE inhibitors.
After about five years, they categorized people according to the level of blood pressure control they achieved.
Those with tight control had blood pressure under 130; those with average control had blood pressure under 140 and those whose blood pressure was over 140 were considered uncontrolled.
“What we found was that the tight control group – those with systolic blood pressure of 130 – did no better with regard to the overall outcome of death, heart attack or stroke. There was no difference, and in fact those they may have done a little worse,” Cooper-DeHoff said in a telephone interview.
But diabetics do need to work on blood pressure control. People in the study whose blood pressure was uncontrolled fared the worst across the board.
“Clearly, we still need to get systolic blood pressure below 140, but less than 130 isn’t any better,” she said.
SOURCE: JAMA, July 7, 2010.