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October 23, 2020 07:00pm
By Sara Karlovitch, Assistant Editor
Even in patients with diabetes, the reduction of systolic blood pressure lead to better outcomes.
In a keynote speech at the Cardiometabolic Health Congress in Boston, SPRINT investigator Suzanne Oparil, MD, discussed how findings from the SPRINT trial and other meta-analyses suggest that a more intensive reduction of systolic blood pressure (BP) leads to better cardiovascular outcomes, but how much lower remains undefined.
Findings from the SPRINT study showed that compared with lowering systolic BP to a target of <140 mm Hg, lowering BP to <120 mm HG conferred reduced risk for the composite primary outcome of myocardial infarction, stroke, heart failure, other acute coronary syndrome (ACS), and death from CV causes, according to a report inHealio.
Although these findings were revealing, Oparil noted that SPRINT had extensive exclusion criteria, including diabetic patients, which leaves a lack of clarity in the results.
In the ACCORD trial, researchers studied the effects of intensive BP control and intensive glycemic control in patients with diabetes. However, the findings were interpreted as showing that intensive BP-lowering does not actually lead to better outcomes, except for stroke in diabetic patients, according to the report.
Despite this, Oparil warned that the trial cannot be considered the definitive conclusion on BP control in patients with diabetes, according toHealio. Notably, intensive BP control was reported to have a greater effect on CV outcomes in patients who were in the standard glycemic control arm compared with those in the intensive glycemic control arm.
In one meta-analysis of trials regarding BP lowering in diabetic patients, researchers found that a 10 mm Hg reduction in systolic BP was associated with a reduced risk of cardiovascular disease, coronary heart disease, albuminuria, stroke, retinopathy, and mortality, according to the report. Furthermore, there was also a trend found toward benefit in heart failure and no benefit in renal failure.
The meta-analysis also examined which classes of BP drugs conferred the most benefit for each outcome, and determined that heart failure was best prevented through the use of diuretics and potentially angiotensin receptor blockers. Calcium channel blockers were found to be beneficial in the prevention of stroke, but not heart failure, while beta-blockers were not found to protect against stroke, but angiotensin receptor blockers were more effective in the prevention of death.
Since findings vary among the different analyses, Oparil stated in the report that individual clinical judgement is critical when it comes to the reduction of systolic blood pressure.
“Individualized assessment of the absolute benefits and risks is vital to shared decision making between patients and clinicians,” Oparil toldHealio. “Lowering BP is generally beneficial, but exactly how much and exactly how far you should go in any individual patient involves assessment of risk and benefit that should be made jointly by the clinician and the patient.”