Your BP Goal Depends On Many Factors.
Our heart expert Simeon Margolis, M.D., Ph.D., is professor of medicine and biological chemistry, Johns Hopkins Medicine
Doctors have known for decades that high blood pressurereadings of 140/90 mm Hg or higheris a major risk for heart disease, stroke, and kidney failure. For people in the general population, the goal of treatment is to get their blood pressure below those numbers.
However, because studies have shown that the risk of cardiovascular events among people with diabetes starts to rise at even lower blood pressure levels, the American Diabetes Association (ADA) used to recommend that people with diabetes aim for a level less than 130/80 mm Hg. But in 2013, the ADA revised its position.
According to recent guidelines, most people with diabetes should aim for a systolic blood pressure reading of less than 140 mm Hg rather than the previous goal of less than 130 mm Hg.
Why the Change in Target Blood Pressure?
Because heart disease is a major concern for people with diabetes, aggressively controlling risk factors such as high blood pressure seemed to make sense. But recent studies have not confirmed the expected benefits of a lower blood pressure goal.
One major surprise came from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure trial. The goal of this study was to determine whether therapy to reach a systolic pressure under 120 mm Hg, rather than under 130 mm Hg, would further reduce the risk of cardiovascular events.
Researchers randomly assigned more than 4,700 participants with long-standing type 2 diabetes to either an intensive-therapy group, whose goal was to attain a systolic level below 120 mm Hg, or a standard therapy group with a systolic goal of less than 140 mm Hg. The average systolic blood pressure for patients at the start of the study was 139 mm Hg.
All participants received nutrition and exercise counseling and were told to use aspirin daily. They also received antihypertensive medication to help them reach their blood pressure goals.
After one year, the intensive treatment group maintained an average systolic blood pressure of 119 mm Hg.
At the end of the five-year trial, the results, published in The New England Journal of Medicine, showed that people on the intensive regimen were no less likely to suffer cardiovascular events than those in the standard treatment group. But they were nearly three times more likely to have serious side effects from therapy, such as blood pressure that was too low or changes in kidney function.
Still, there was some evidence that, when cardiovascular events were broken down by type, intensive treatment lowered the rate of strokes. However, because so few strokes occurred, the researchers weren't sure if this finding was a matter of chance, requiring further investigation.
The Bottom Line
The ADA's decision to raise the recommended blood pressure target is not meant to downplay the importance of treating high blood pressure in people with diabetes. Therefore, the ADA continues to recommend lifestyle changes, as opposed to pharmacologic treatment, to reduce systolic blood pressure that is higher than 120 mm Hg.
The ADA's new position does still suggest that a lower systolic target may be appropriate for some younger people with diabetes. It's also possible that some people who are at a very high risk for stroke could benefit from a lower target. That said, the new higher target may allow some people to stop taking blood pressure medications to avoid side effectsas long as their systolic pressure remains below 140 mm Hg. Talk to your doctor to determine what's right for you based on your personal health history.
Source: from our sister publication Diabetes Focus Fall 2014