Δημοσίευση

Blood pressure reduction in diabetes: lessons from ACCORD, SPRINT and EMPA-REG OUTCOME.

ΤίτλοςBlood pressure reduction in diabetes: lessons from ACCORD, SPRINT and EMPA-REG OUTCOME.
Publication TypeJournal Article
Year of Publication2017
AuthorsSarafidis, P. A., Lazaridis A. A., Ruiz-Hurtado G., & Ruilope L. M.
JournalNat Rev Endocrinol
Volume13
Issue6
Pagination365-374
Date Published2017 06
ISSN1759-5037
Λέξεις κλειδιάAntihypertensive Agents, Benzhydryl Compounds, Blood Pressure, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glucosides, Humans, Hypertension, Practice Guidelines as Topic, Randomized Controlled Trials as Topic, Reference Values, Treatment Outcome
Abstract

In patients with diabetes mellitus, the presence of hypertension substantially increases the risk of cardiovascular events, and reductions in blood pressure (BP) can reduce cardiovascular morbidity and mortality. Following evidence from trials randomizing patients to diastolic BP levels, previous guidelines recommended an office BP target of <130/80 mmHg in individuals with diabetes mellitus. However, the evidence for this systolic BP (SBP) target was derived from observational studies. When the results of the ACCORD-BP study showed that those individuals with diabetes mellitus and a target BP of <120 mmHg had a cardiovascular risk that is similar to those with <140 mmHg, all guidelines returned to a recommended SBP of <140 mmHg. However, the ACCORD-BP trial was limited by the low number of cardiovascular events observed, whereas the mean SBP in the 'conventional' arm was 133 mmHg. The SPRINT study, showing cardiovascular benefits in hypertensive patients without diabetes mellitus randomized to SBP <120 mmHg versus those randomized to <140 mmHg, came in contrast with the ACCORD-BP, but a detailed evaluation reveals many similarities between the two trials. Finally, the EMPA-REG OUTCOME study, with impressive cardiovascular mortality reduction with empagliflozin, suggested that reduction of SBP to around 130 mmHg is safe and might explain part of these beneficial results. In this Review, we evaluate the implications of the ACCORD-BP, SPRINT and EMPA-REG OUTCOME trials and previous studies for the optimal BP target in diabetes mellitus.

DOI10.1038/nrendo.2016.209
Alternate JournalNat Rev Endocrinol
PubMed ID28106149

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