Intensive blood pressure targets didn't reduce mortality in type 2 diabetes

Intensive hypertension treatment slightly reduced the risk of stroke in type 2 diabetics, but had no effect on mortality or myocardial infarction, a new review found.

Researchers conducted a meta-analysis of randomized trials comparing blood pressure treatment to intensive targets (upper limit 130 mm Hg systolic and 80 mm Hg diastolic) and standard targets (upper limit 140-160 mm Hg systolic and 85-100 mm Hg diastolic) in patients with type 2 diabetes. The review covered five studies (including the UKPDS and ACCORD-BP trials) with more than 7,000 participants.

Results were published by Archives of Internal Medicine on Aug. 7.

Using a random-effects model, the review authors found that patients treated to intensive targets did not significantly differ from standard-targeted patients in their rates of mortality (relative risk [RR], 0.76; 95% CI, 0.55 to 1.05) or myocardial infarction (RR, 0.93; 95% CI, 0.80 to 1.08). The intensive targets were associated with a decrease in the risk of stroke (RR, 0.65; 95% CI, 0.48 to 0.86). A pooled analysis of risk differences showed only a small absolute decrease in stroke risk (absolute risk, −0.01; 95% CI, −0.02 to −0.00) and no effect on mortality or myocardial infarction.

The researchers also looked at the benefits of standard blood pressure targets compared to historical treatment, defined as a blood pressure target higher than standard targets or as treatment in which a placebo or usual care was provided, and observed a much greater difference than they found between standard and intensive treatment. The number needed to treat to achieve benefit with intensive treatment is threefold what it is for standard treatment compared to historical treatment, they calculated. They concluded that intensive blood pressure targets do not appear to reduce the risk of mortality or myocardial infarction.

Current guidelines recommend targets of 130/80 mm Hg or less for patients with type 2 diabetes, the authors noted. Based on the review, they were not able to recommend a specific alternative target, but they suggested that their findings be considered in future guideline development.

According to an accompanying commentary, future guidelines are likely to suggest a target of 140/90 mm Hg or less.

“Physicians need to understand and discuss these goals with their patients,” the commentary authors concluded.