Intensive blood pressure lowering treatment may harm people with diabetes

February 24, 2016
This study shows that intensive blood pressure lowering treatment using antihypertensive drugs may be harmful for people with diabetes and a systolic blood pressure less than 140 mm Hg. Credit: Mostphotos

People with diabetes often have high blood pressure and an increased cardiovascular risk. They are therefore often recommended more intensive blood pressure lowering treatment that non-diabetics. However, for patients with systolic blood pressure levels under 140, antihypertensive drugs may increase the risk of dying from cardiovascular causes. This according to a study at Umeå University in Sweden published in the BMJ.

"Our study shows that intensive blood pressure lowering treatment using may be harmful for people with diabetes and a systolic blood pressure less than 140 mm Hg," says Mattias Brunström, doctoral student at the Department of Public Health and Clinical Medicine, and main author of the article.

"At the same time, it is important to remember that blood pressure lowering treatment is crucial for the majority of people with diabetes whose blood pressure measures above 140."

In the study, published in the BMJ (British Medical Journal), researchers Mattias Brunström and Bo Carlberg from Umeå University, have carried out a systematic review and meta-analyses of the medical literature. By analysing all published studies, together with a number of unpublished patient data, the researchers have been able to investigate the effects of blood pressure-lowering drugs in diabetes patients.

The study shows that the effects of antihypertensive treatment depend on the blood pressure level of the patient before treatment. If the systolic blood pressure before treatment was higher than 140 mm Hg, treatment was associated with a decreased risk of death, stroke, heart attack and heart failure. If the before treatment was less than 140 mm Hg, however, the risk of cardiovascular death increased. The results are nearly exclusively based upon data from patients with type 2 diabetes and previous antihypertensive treatment. Therefore, no conclusions can be made on patients with type 1 diabetes or patients with diabetes and normal blood pressure levels.

"In practice, it is important to remember that undertreatment of is a bigger problem than overtreatment," emphasises Mattias Brunström.

"Many treatment guidelines, both Swedish and international, will be redrawn in the next few years. It has been discussed to recommend even lower for people with - maybe as low as 130. We are hoping that our study, which shows potential risks of such aggressive blood pressure lowering treatment, will come to influence these guidelines."

About the study:

In a comprehensive study, Mattias Brunström and Bo Carlberg analysed all randomised controlled trials that compared any antihypertensive agents against placebo. Apart from published studies, they also managed to collect a large amount of previously unpublished data. The results were compiled in separate meta-analyses depending on what patients had at the start of each respective study.

Explore further: Treat 'normal' blood pressure to save lives, study urges

More information: British Medical Journal, dx.doi.org/10.1136/bmj.i717

Related Stories

Treat 'normal' blood pressure to save lives, study urges

December 24, 2015
Millions of lives could be saved by giving blood pressure-lowering drugs to people at risk of heart attack and stroke, even if they have normal pressure, researchers said Thursday.

Lower systolic blood pressure reduces risk of hypertension complication

October 13, 2015
Lowering systolic blood pressure below the currently recommended target can reduce the risk of left ventricular hypertrophy (LVH), the most common complication of high blood pressure, according to new research.

Effect of reducing blood pressure with medications immediately following ischemic stroke

November 17, 2013
Jiang He, M.D., Ph.D., of the Tulane University School of Public Health and Tropical Medicine, New Orleans, and colleagues examined whether moderate lowering of blood pressure within the first 48 hours after the onset of ...

BP-lowering treatment for type 2 diabetes linked to longer survival

February 10, 2015
Blood pressure-lowering treatment among patients with type 2 diabetes is associated with a lower risk of cardiovascular disease (CVD) and heart disease events and improved mortality, according to a study in the February 10 ...

Authors urge caution before adopting new systolic BP goals

February 24, 2016
(HealthDay)—A small reduction as the primary composite outcome may not justify the increased adverse events and costs associated with an intervention targeting systolic blood pressure (BP) less than 120 mm Hg, according ...

New blood pressure guidelines a danger to patients: study

February 1, 2016
(HealthDay)—Scientists continue to debate when doctors should prescribe blood pressure medication for older Americans, with a new study saying delayed treatment puts people at greater risk of stroke.

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.