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Recommendation
| Appreciate that tight BP control in patients with diabetes is associated with reductions in cardiovascular outcomes and deaths and that optimal BP targets differ depending on diabetes status.
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Evidence:
- The HOT trial found that persons with diabetes randomly assigned to a target diastolic BP of 80 mm Hg had a 51% reduction in cardiovascular events (NNT, 8) and a 67% reduction in cardiovascular death (NNT, 14) after 5 years when compared with those assigned to a target of 90 mm Hg. Interestingly, lowering the diastolic BP target from 90 mm Hg to 80 mm Hg was not found to be beneficial in subjects without diabetes (89).
- In the UKPDS, newly diagnosed patients with type 2 diabetes and hypertension randomly assigned to tight BP control (
 150/85 mm Hg) for 10 years had a significant reduction in diabetes-related deaths (RR, 0.68 [CI, 0.49 to 0.94]), as well as a reduction in stroke (RR, 0.56 [CI, 0.35 to 0.89]), any diabetes-related endpoint (RR, 0.76 [CI 0.62 to 0.92], and risk of microvascular complications. The NNT to prevent any diabetes complication was 6.1 (2.6 to 9.5), and to prevent a diabetes-related death, 15.0 (12.1 to 17.9) (90).
- Two other small randomized controlled trials have shown significant reductions in all-cause mortality (91) and in strokes (92) in patients with diabetes given intensive BP therapy.
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Comments:
- All of these studies were conducted predominantly in persons with clinically diagnosed diabetes rather than through screening.
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| Denice S. Feig, MD, MSc, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lorraine Lipscombe, MD, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Sonal Singh, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for continuing medical education grand rounds and lectures given. |
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Screening for Type 2 Diabetes
> Effectiveness/Harms of Early Treatment
