Lower blood pressure for diabetic patients reduces cardiovascular disease
Major events decreased when patients with Type 2 diabetes had systolic readings closer to 120, study led by UTSW researcher shows
DALLAS – Nov. 16, 2024 – People with Type 2 diabetes had significantly fewer heart attacks, strokes, heart failures, and deaths from cardiovascular disease when their blood pressure was lower than the current standard goal, a UT Southwestern Medical Center researcher and his colleagues found. The research, published in The New England Journal of Medicine, offers evidence for developing new clinical guidelines for improving cardiovascular health in this growing population.
“These results provide support for more intensive systolic blood pressure control in patients with diabetes to prevent major cardiovascular events,” said Jiang He, M.D., Ph.D., Professor and Chair of Epidemiology in the Peter O’Donnell Jr. School of Public Health at UT Southwestern and one of the senior authors of the study.
Systolic blood pressure – the “top” number in a clinical blood pressure reading – measures the pressure the blood pushes against artery walls when the heart beats. Dr. He explained that most current clinical guidelines recommend patients with Type 2 diabetes maintain a systolic blood pressure of less than 130 mm Hg. However, little evidence exists to support this recommendation.
The Systolic Blood Pressure Intervention Trial showed a significantly lower risk of major cardiovascular disease for participants with a systolic treatment target of less than 120 compared to those with a target of less than 140. However, no patients with diabetes were included in that study.
To better understand whether a lower systolic blood pressure might have a cardiovascular benefit for people with diabetes, Dr. He and colleagues launched the Blood Pressure Control Target in Diabetes trial. The researchers recruited 12,821 patients with Type 2 diabetes who had elevated systolic blood pressure and were considered at increased risk of cardiovascular disease. The patients’ average age was nearly 64, and about 45% were women.
The participants were randomly assigned to one of two groups targeting different goals for systolic blood pressure: either a standard treatment goal of less than 140 or an intensive-treatment goal of less than 120. Doctors were encouraged to use clinical guideline-recommended antihypertensive medications to achieve these goals. For up to five years, participants were followed to track their blood pressure, major cardiovascular diseases, including nonfatal strokes and heart attacks, treatment or hospitalization for heart failure, death due to cardiovascular causes, and adverse events related to antihypertensive treatment.
After the participants started their blood pressure medication regimens, their systolic blood pressure quickly dropped to near or within the target numbers. At their one-year follow-up, the 6,407 patients in the standard-target group had an average systolic blood pressure of 133.2, and the 6,414 patients in the intensive-target group had an average reading of 121.6.
At their four-year follow-up, the difference in major cardiovascular events between the groups was clear: Intensive blood pressure treatment further reduced cardiovascular disease by 21% compared to standard treatment, Dr. He said. While the standard-target group experienced 492 events, mostly strokes, the intensive-target group had only 393, a statistically significant difference. Both groups had similar numbers of serious adverse events, although the intensive-target group had more incidences of hypotension (blood pressure that was too low) and hyperkalemia (excessive potassium in the blood).
Together, Dr. He said, these results demonstrate that more aggressive treatment for high blood pressure that achieves a systolic reading closer to 120 could prevent more cardiovascular events in patients with Type 2 diabetes. These findings support developing new clinical guidelines to further reduce blood pressure in patients with diabetes and hypertension, he said.
Dr. He, who is also Professor of Internal Medicine and Neurology, holds the S. Roger and Carolyn P. Horchow Chair in Cardiac Research, in Honor of Jere H. Mitchell, M.D.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 25 members of the National Academy of Sciences, 24 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.