Tight BP Control May Not Benefit Patients With Diabetes, CAD

Groups with tight, moderate control of systolic BP have similar rate of adverse outcomes
By Monica Smith
HealthDay Reporter

TUESDAY, July 6 (HealthDay News) -- Individuals with diabetes and coronary artery disease (CAD) do not appear to have improved cardiovascular outcomes when they achieve tight control of systolic blood pressure as opposed to usual control, according to research published in the July 7 issue of the Journal of the American Medical Association.

Rhonda M. Cooper-DeHoff, of the University of Florida in Gainesville, and colleagues performed a subgroup analysis on 6,400 subjects over the age of 50 with diabetes and CAD, who had varying degrees of control over their systolic blood pressure, to determine an association between blood pressure control and cardiovascular outcomes in this patient population. The subjects were participants in the International Verapamil SR-Trandolapril Study (INVEST).

In 16,893 patient-years of follow-up, the researchers found that death, nonfatal myocardial infarction, or nonfatal stroke occurred in 286 subjects (12.7 percent) who achieved tight systolic blood pressure (under 130 mm Hg), 249 subjects (12.6 percent) who maintained usual systolic blood pressure (130 to less than 140 mm Hg), and 431 subjects (19.8 percent) who had uncontrolled blood pressure (140 mm Hg or higher). With extended follow-up, the tight-control group had an all-cause mortality risk of 22.8 percent, compared with 21.8 in the usual-control group.

"At this time, there is no compelling evidence to indicate that lowering systolic blood pressure below 130 mm Hg is beneficial for patients with diabetes; thus, emphasis should be placed on maintaining systolic blood pressure between 130 and 139 mm Hg while focusing on weight loss, healthful eating, and other manifestations of cardiovascular morbidity to further reduce long-term cardiovascular risk," the authors conclude.

Abbott Laboratories provided funding for INVEST. Four authors disclosed financial relationships with Abbott and other pharmaceutical and/or medical device companies.

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