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Even Without HTN, BP Meds Benefit Diabetes Patients

A new analysis indicates that people with type 2 diabetes are less likely to suffer myocardial infarctions, strokes, or early mortality when they take blood pressure medications -- even if they don't actually have hypertension…

The study was done to determine the associations between BP–lowering treatment and vascular disease in type 2 diabetes.

Kazem Rahimi, M.D., deputy director with the George Institute for Global Health at the University of Oxford in the United Kingdom, and colleagues analyzed 40 studies with a total of 100,354 participants randomized to blood pressure-lowering treatment or placebo.

Each decrease of 10 mm Hg in systolic blood pressure reading reduced the risk of early death by 13%, myocardial infarctions and similar problems by 11%, coronary heart disease by 12%, and stroke by 27%. The researchers also found that the risk of albuminuria and retinopathy fell, by 17 and 13%, respectively. The positive effect of the drugs was smaller in participants with lower blood pressure levels.

Bryan Williams, M.D., a professor of medicine with University College London who studies hypertension and diabetes, said in a press release that, the review findings suggest "we should consider lowering blood pressure further than recommended in current guidelines" to reduce the risk of stroke.

They searched Medline for large-scale randomized controlled trials of BP–lowering treatment including patients with diabetes, published between January 1966 and October 2014.

The main outcomes were all-cause mortality, cardiovascular events, coronary heart disease events, stroke, heart failure, retinopathy, new or worsening albuminuria, and renal failure.

The results used 40 trials judged to be of low risk of bias (100 354 participants) were included. Each 10–mm Hg lower systolic BP was associated with a significantly lower risk of mortality (relative risk [RR], 0.87; 95% CI, 0.78-0.96); absolute risk reduction (ARR) in events per 1000 patient-years (3.16; 95% CI, 0.90-5.22), cardiovascular events (RR, 0.89 [95% CI, 0.83-0.95]; ARR, 3.90 [95% CI, 1.57-6.06]), coronary heart disease (RR, 0.88 [95% CI, 0.80-0.98]; ARR, 1.81 [95% CI, 0.35-3.11]), stroke (RR, 0.73 [95% CI, 0.64-0.83]; ARR, 4.06 [95% CI, 2.53-5.40]), albuminuria (RR, 0.83 [95% CI, 0.79-0.87]; ARR, 9.33 [95% CI, 7.13-11.37]), and retinopathy (RR, 0.87 [95% CI, 0.76-0.99]; ARR, 2.23 [95% CI, 0.15-4.04]). When trials were stratified by mean baseline systolic BP at greater than or less than 140 mm Hg, RRs for outcomes other than stroke, retinopathy, and renal failure were lower in studies with greater baseline systolic BP (P interaction <0.1). The associations between BP-lowering treatments and outcomes were not significantly different, irrespective of drug class, except for stroke and heart failure. Estimates were similar when all trials, regardless of risk of bias, were included.

From the results it was concluded that, among patients with type 2 diabetes, BP lowering was associated with improved mortality and other clinical outcomes with lower RRs observed among those with baseline BP of 140 mm Hg and greater. These findings support the use of medications for BP lowering in these patients.

Practice Pearls

•  Each decrease of 10mm Hg in systolic blood pressure reading reduced the risk of early death by 13%.

Each decrease of 10mm Hg in systolic blood pressure reading reduced myocardial infarctions and similar problems by 11%.

Each decrease of 10mm Hg in systolic blood pressure reading reduced, coronary heart disease by 12%, and stroke by 27%.

The researchers also found that the risk of albuminuria and retinopathy fell, by 17 and 13%, respectively.
Source: Journal of the American Medical Association 2015
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