Skip to main content
Erschienen in: Current Cardiology Reports 6/2015

01.06.2015 | Diabetes and Cardiovascular Disease (S Malik, Section Editor)

Update on Blood Pressure Goals in Diabetes Mellitus

verfasst von: Luke J. Laffin, George L. Bakris

Erschienen in: Current Cardiology Reports | Ausgabe 6/2015

Einloggen, um Zugang zu erhalten

Abstract

The most recent guideline statements by the 2014 Expert Panel of the National Institutes of Health as well as the American and International Societies of Hypertension recommend a blood pressure goal of <140/90 mmHg in patients with diabetes mellitus. This follows prior guidelines that recommended lower BP treatment goals of <130/80 mmHg in patients with diabetes. Reducing cardiovascular morbidity and mortality by trying to achieve recommended goals of risk factors like blood pressure, glucose, and cholesterol in patients with diabetes is paramount. Data from multiple trials demonstrates that early treatment of hypertension in people with diabetes clearly prevents both macrovascular and microvascular complications, but the goal blood pressure that should be achieved is now modified to a higher level. We address the evidence and evolution of how and why this blood pressure goal has changed in recent years.
Literatur
1.
Zurück zum Zitat Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama. 2003;289(19):2560–72. doi:10.1001/jama.289.19.2560.CrossRefPubMed Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama. 2003;289(19):2560–72. doi:10.​1001/​jama.​289.​19.​2560.CrossRefPubMed
3.•
Zurück zum Zitat Bakris G. Chronic kidney disease: optimal blood pressure for kidney disease-lower is not better. Nat Rev Nephrol. 2013;9(11):634–5. doi:10.1038/nrneph.2013.206. Paper reviews all the studies and provides a perspective on renal outcomes and BP goal.PubMed Bakris G. Chronic kidney disease: optimal blood pressure for kidney disease-lower is not better. Nat Rev Nephrol. 2013;9(11):634–5. doi:10.​1038/​nrneph.​2013.​206. Paper reviews all the studies and provides a perspective on renal outcomes and BP goal.PubMed
4.
Zurück zum Zitat Barzilay JI, Howard AG, Evans GW, Fleg JL, Cohen RM, Booth GL, et al. Intensive blood pressure treatment does not improve cardiovascular outcomes in centrally obese hypertensive individuals with diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial. Diabetes Care. 2012;35(7):1401–5. doi:10.2337/dc11-1827.CrossRefPubMedCentralPubMed Barzilay JI, Howard AG, Evans GW, Fleg JL, Cohen RM, Booth GL, et al. Intensive blood pressure treatment does not improve cardiovascular outcomes in centrally obese hypertensive individuals with diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial. Diabetes Care. 2012;35(7):1401–5. doi:10.​2337/​dc11-1827.CrossRefPubMedCentralPubMed
5.•
Zurück zum Zitat James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. doi:10.1001/jama.2013.284427. Expert panel report with strong evidence provided for guidance made.CrossRefPubMed James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. doi:10.​1001/​jama.​2013.​284427. Expert panel report with strong evidence provided for guidance made.CrossRefPubMed
6.•
Zurück zum Zitat Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens. 2014;16(1):14–26. doi:10.1111/jch.12237. A unified American and International guidance paper on BP guidelines. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens. 2014;16(1):14–26. doi:10.​1111/​jch.​12237. A unified American and International guidance paper on BP guidelines.
8.
Zurück zum Zitat Hypertension in Diabetes Study (HDS). I. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. J Hypertens. 1993;11(3):309–17. Hypertension in Diabetes Study (HDS). I. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. J Hypertens. 1993;11(3):309–17.
9.
Zurück zum Zitat Parving HH, Hommel E, Mathiesen E, Skott P, Edsberg B, Bahnsen M, et al. Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. Br Med J. 1988;296(6616):156–60. Parving HH, Hommel E, Mathiesen E, Skott P, Edsberg B, Bahnsen M, et al. Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. Br Med J. 1988;296(6616):156–60.
10.
Zurück zum Zitat Levin A, Stevens PE. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int. 2014;85(1):49–61. Levin A, Stevens PE. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int. 2014;85(1):49–61.
11.•
Zurück zum Zitat Bakris GL, Molitch M. Microalbuminuria as a risk predictor in diabetes: the continuing saga. Diabetes Care. 2014;37(3):867–75. doi:10.2337/dc13-1870. Provides an evidence based look at microalbuminuria in diabetes and evaluation of outcome predictor.CrossRefPubMed Bakris GL, Molitch M. Microalbuminuria as a risk predictor in diabetes: the continuing saga. Diabetes Care. 2014;37(3):867–75. doi:10.​2337/​dc13-1870. Provides an evidence based look at microalbuminuria in diabetes and evaluation of outcome predictor.CrossRefPubMed
12.
13.
Zurück zum Zitat Nosadini R, Sambataro M, Thomaseth K, Pacini G, Cipollina MR, Brocco E, et al. Role of hyperglycemia and insulin resistance in determining sodium retention in non-insulin-dependent diabetes. Kidney Int. 1993;44(1):139–46.PubMed Nosadini R, Sambataro M, Thomaseth K, Pacini G, Cipollina MR, Brocco E, et al. Role of hyperglycemia and insulin resistance in determining sodium retention in non-insulin-dependent diabetes. Kidney Int. 1993;44(1):139–46.PubMed
14.
Zurück zum Zitat Randeree HA, Omar MA, Motala AA, Seedat MA. Effect of insulin therapy on blood pressure in NIDDM patients with secondary failure. Diabetes Care. 1992;15(10):1258–63.CrossRefPubMed Randeree HA, Omar MA, Motala AA, Seedat MA. Effect of insulin therapy on blood pressure in NIDDM patients with secondary failure. Diabetes Care. 1992;15(10):1258–63.CrossRefPubMed
15.
Zurück zum Zitat Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106(16):2085–90.CrossRefPubMed Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106(16):2085–90.CrossRefPubMed
16.
Zurück zum Zitat Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal TP, Hemmingsen C, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013;11, CD008143. doi:10.1002/14651858.CD008143.pub3.PubMed Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal TP, Hemmingsen C, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013;11, CD008143. doi:10.​1002/​14651858.​CD008143.​pub3.PubMed
17.
Zurück zum Zitat Gaede P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet. 1999;353(9153):617–22. doi:10.1016/S0140-6736(98)07368-1.PubMed Gaede P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet. 1999;353(9153):617–22. doi:10.​1016/​S0140-6736(98)07368-1.PubMed
18.
Zurück zum Zitat Anonymous. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317:703–13. Anonymous. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317:703–13.
19.
Zurück zum Zitat Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351(9118):1755–62.PubMed Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351(9118):1755–62.PubMed
20.
Zurück zum Zitat Patel A, Group AC, MacMahon S, Chalmers J, Neal B, Woodward M, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007;370(9590):829–40. doi:10.1016/S0140-6736(07)61303-8.PubMed Patel A, Group AC, MacMahon S, Chalmers J, Neal B, Woodward M, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007;370(9590):829–40. doi:10.​1016/​S0140-6736(07)61303-8.PubMed
21.
Zurück zum Zitat Group AS, Cushman WC, Evans GW, Byington RP, Goff Jr DC, Grimm Jr RH, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575–85. doi:10.1056/NEJMoa1001286. Group AS, Cushman WC, Evans GW, Byington RP, Goff Jr DC, Grimm Jr RH, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575–85. doi:10.​1056/​NEJMoa1001286.
25.
Zurück zum Zitat Weber MA, Bakris GL, Jamerson K, Weir M, Kjeldsen SE, Devereux RB, et al. Cardiovascular events during differing hypertension therapies in patients with diabetes. J Am Coll Cardiol. 2010;56(1):77–85. doi:10.1016/j.jacc.2010.02.046.PubMed Weber MA, Bakris GL, Jamerson K, Weir M, Kjeldsen SE, Devereux RB, et al. Cardiovascular events during differing hypertension therapies in patients with diabetes. J Am Coll Cardiol. 2010;56(1):77–85. doi:10.​1016/​j.​jacc.​2010.​02.​046.PubMed
26.
Zurück zum Zitat Investigators O, Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547–59. doi:10.1056/NEJMoa0801317. Investigators O, Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547–59. doi:10.​1056/​NEJMoa0801317.
27.
Zurück zum Zitat Berl T, Hunsicker LG, Lewis JB, Pfeffer MA, Porush JG, Rouleau JL, et al. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol: JASN. 2005;16(7):2170–9. doi:10.1681/ASN.2004090763.PubMed Berl T, Hunsicker LG, Lewis JB, Pfeffer MA, Porush JG, Rouleau JL, et al. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol: JASN. 2005;16(7):2170–9. doi:10.​1681/​ASN.​2004090763.PubMed
28.
Zurück zum Zitat Bakris GL, Weir MR, Shanifar S, Zhang Z, Douglas J, van Dijk DJ, et al. Effects of blood pressure level on progression of diabetic nephropathy: results from the RENAAL study. Arch Intern Med. 2003;163(13):1555–65. doi:10.1001/archinte.163.13.1555.PubMed Bakris GL, Weir MR, Shanifar S, Zhang Z, Douglas J, van Dijk DJ, et al. Effects of blood pressure level on progression of diabetic nephropathy: results from the RENAAL study. Arch Intern Med. 2003;163(13):1555–65. doi:10.​1001/​archinte.​163.​13.​1555.PubMed
29.
Zurück zum Zitat Wheeler DC, Becker GJ. Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease? Kidney Int. 2013;83(3):377–83. doi:10.1038/ki.2012.425.PubMed Wheeler DC, Becker GJ. Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease? Kidney Int. 2013;83(3):377–83. doi:10.​1038/​ki.​2012.​425.PubMed
30.
Zurück zum Zitat Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357. doi:10.1097/01.hjh.0000431740.32696.cc.PubMed Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357. doi:10.​1097/​01.​hjh.​0000431740.​32696.​cc.PubMed
32.
Zurück zum Zitat Bakris GL, Fonseca V, Katholi RE, McGill JB, Messerli FH, Phillips RA, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. Jaxma. 2004;292(18):2227–36. doi:10.1001/jama.292.18.2227. Bakris GL, Fonseca V, Katholi RE, McGill JB, Messerli FH, Phillips RA, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. Jaxma. 2004;292(18):2227–36. doi:10.​1001/​jama.​292.​18.​2227.
Metadaten
Titel
Update on Blood Pressure Goals in Diabetes Mellitus
verfasst von
Luke J. Laffin
George L. Bakris
Publikationsdatum
01.06.2015
Verlag
Springer US
Erschienen in
Current Cardiology Reports / Ausgabe 6/2015
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-015-0591-y

Weitere Artikel der Ausgabe 6/2015

Current Cardiology Reports 6/2015 Zur Ausgabe

Interventional Cardiology (S Rao, Section Editor)

Transradial Sheathless Approach for PCI

Diabetes and Cardiovascular Disease (S Malik, Section Editor)

Impact of Functional Foods on Prevention of Cardiovascular Disease and Diabetes

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.