Tight blood pressure control in patients with DM and CAD

Current guidelines are in place regarding treating hypertension in patients with diabetes.

These US researchers examined the association of systolic BP control and cardiovascular outcomes in a cohort of patients with both diabetes and CAD.

They utilized an observational subgroup analysis of 6400 of the 22 576 participants in the International Verapamil SR- Trandolapril Study (INVEST), a multinational study. Participants were at least 50 years old and had diabetes and CAD. Patients received first-line treatment of either a calcium channel blocker or-beta blocker followed by angiotensin- converting enzyme inhibitor, a diuretic, or both to achieve systolic BP of less than 130 mm Hg and diastolic BP of less than 85 mm Hg.

Patients were categorized as having tight control if their systolic pressures were maintained at less than 130 mm Hg, usual control if it ranged from 130 mm Hg to less than 140 mm Hg, and uncontrolled if it was 140 mm Hg or higher.

The researchers found: "During 16 893 patient-years of follow-up, 286 patients (12.7 percent) who maintained tight control, 249 (12.6 percent) who had usual control, and 431 (19.8 percent) who had uncontrolled systolic BP experienced a primary outcome event. Patients in the usual-control group had a cardiovascular event rate of 12.6 percent vs a 19.8 percent event rate for those in the uncontrolled group (adjusted hazard ratio)

The researchers concluded: "Tight control of systolic BP among patients with diabetes and CAD was not associated with improved cardiovascular outcomes compared with usual control."
This large study found no benefit to tight vs usual control of blood pressure in patients with both DM and CAD

JAMA 304(1):61-68, 7 July 2010 © 2010 the American Medical AssociationTight Blood Pressure Control and Cardiovascular Outcomes Among Hypertensive Patients With Diabetes and Coronary Artery Disease, July 7, 2010, Cooper-DeHoff et al.. Rhonda M. Cooper-DeHoff, Yan Gong, Eileen M. Handberg et al.