Study on Intensive Treatment for High Blood Pressure and Diabetes

Introduction

A recent study evaluated whether intensive treatment of patients suffering from high blood pressure and diabetes could decrease the risk of adverse events or mortality. Hypertension is a recognized risk factor for cardiovascular disease, contributing to serious conditions such as heart attacks, strokes, and premature death.

Current Treatment Landscape

Despite the availability of numerous antihypertensive medications, there remains a lack of consensus regarding the appropriate timing for initiating treatment and the target blood pressure for these patients. Recent research indicates that blood pressure targets may need to be lower than previously recommended.

Findings from Recent Trials

For example, the SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated that individuals whose systolic blood pressure was lowered to below 120 mmHg through therapeutic intervention experienced significantly reduced rates of adverse events and mortality compared to those whose systolic readings were maintained below 140 mmHg. Similarly, the HOPE-3 (Heart Outcomes Prevention Evaluation-3) trial found that greater reductions in blood pressure were associated with a lower risk of negative cardiovascular outcomes.

Contradictory Evidence in Diabetic Patients

While the SPRINT and HOPE-3 trials suggest that lower blood pressure targets may benefit patients with hypertension, the applicability of these findings to individuals with both hypertension and type 2 diabetes is less clear. The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, in contrast to SPRINT, revealed no significant differences in outcomes for patients whose systolic blood pressure was maintained at either less than 120 mmHg or less than 140 mmHg.

Guideline Disparities

These conflicting results have led to variations in guidelines regarding when to begin treatment and what blood pressure targets to set for patients who are both diabetic and hypertensive.

The ADVANCE Trial

A recent trial, known as the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), examined outcomes from nearly 11,000 patients to determine the effectiveness of intensive blood pressure treatment in those with both hypertension and diabetes. The study compared rates of overall mortality, major vascular events such as heart attacks and strokes, and diabetes-related complications affecting the kidneys and eyes between patients receiving intensive treatment and a placebo control group.

Study Findings

The results indicated that, irrespective of the patients’ baseline blood pressure, an intensive treatment regimen aimed at maintaining lower blood pressure targets was linked to a 9% reduction in adverse events and a 14% decrease in mortality.

Conclusion

In summary, the ADVANCE trial offers further support for the use of intensive blood pressure treatments in patients who have both hypertension and diabetes.

Author Information

Written by Haisam Shah, BSc

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Reference

Rahman, F., McEvoy, J. W., Ohkuma, T., Marre, M., Hamet, P., Harrap, S., … & Muntner, P. (2019). Effects of Blood Pressure Lowering on Clinical Outcomes According to Baseline Blood Pressure and Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus: The ADVANCE Trial. Hypertension, HYPERTENSIONAHA-118.