BP goals for diabetics, too tough?
December 11, 2010
Aggressively controlling blood pressure in diabetics with heart disease may do
little to reduce their risks of dying early and may even be dangerous, U.S.
They found that using a combination of drugs to keep diabetic patients' top
blood pressure readings below 130 offered no benefit over those whose top
reading was below 140 -- the cutoff point for high blood pressure. Normal blood
pressure for healthy people is considered to be 120/80 or lower.
"Clearly, patients and doctors work very hard to get diabetic patients' blood
pressure to less than 130. Our data would suggest maybe we can stop at two drugs
instead of three. And maybe we can spend a little more time talking about diet
and exercise and cholesterol," Rhonda Cooper-DeHoff of the University of Florida
and colleagues wrote in the Journal of the American Medical Association . The
study is the latest to look at whether treating diabetics aggressively with
drugs to control their risk of a heart attack or stroke has any benefit. Several
teams have found it in fact can be dangerous for some patients.
A five-year, U.S. government-backed study dubbed ACCORD was stopped temporarily
in February 2008 because 20 percent more diabetics with heart problems who got
intensive treatment to lower their blood sugar died compared to those treated
more conservatively. [ID:nN14199420] The patients getting the tougher treatment
were transferred into the gentler group and the trial continued.
The latest long-term results, reported at the American Diabetes Association
meeting last week, showed using more drugs to control blood pressure did little
to prevent heart problems. [ID:nN29164664] Cooper-DeHoff said most of the
patients in the ACCORD trial did not have heart disease. Her team looked
specifically at 6,400 diabetics with heart disease taking part in an
international trial that examined different combinations of several common drug
treatments to control blood pressure -- diuretics, calcium channel blockers and
After about five years, they categorised people according to the level of blood
pressure control they achieved. Those with tight control had blood pressure
under 130; those with average control had blood pressure under 140 and those
whose blood pressure was over 140 were considered uncontrolled.
"What we found was that the tight control group -- those with systolic blood
pressure of 130 -- did no better with regard to the overall outcome of death,
heart attack or stroke. There was no difference, and in fact those they may have
done a little worse," Cooper-DeHoff said in a telephone interview. But diabetics
do need to work on blood pressure control. People in the study whose blood
pressure was uncontrolled fared the worst across the board. "Clearly, we still
need to get systolic blood pressure below 140, but less than 130 isn't any
better," she said.