Antihypertensives in Diabetes: Do the Benefits Outweigh the Risks?

Blood pressure medication increased the risk of all-cause and cardiovascular-related mortality in patients with diabetes whose systolic blood pressure (SBP) was below 140 mm Hg, according to a new study.

To determine whether antihypertensive medication affects patients with diabetes at different SBP levels, researchers gathered information from 4 databases on 73,738 patients who were treated for diabetes for at least 12 months.
________________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Managing Challenging Resistant Hypertension Cases
Could Vitamin D Supplements Effectively Reduce Hypertension?
________________________________________________________________________________________________________________________________________________________________________

Most of the patients in the trials had type 2 diabetes, and trials tested antihypertensive medication against placebo.

After a 4-year follow-up, researchers found that patients with diabetes whose SBP was lower than 140 mm Hg at baseline had an increased risk of all-cause and cardiovascular mortality.

However, those with an SBP above 150 mm Hg had a reduced risk of all-cause mortality, cardiovascular mortality, heart attack, stroke, and end-stage kidney disease. Those with an SBP between 140 and 150 had a reduced risk of all-cause mortality, heart attack, and heart failure with additional treatment.

“Antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with diabetes mellitus and a systolic blood pressure more than 140 mm Hg,” researchers concluded. “If systolic blood pressure is less than 140 mm Hg, however, further treatment is associated with an increased risk of cardiovascular death, with no observed benefit.”

—Amanda Balbi

Reference:

Brunström M and Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ. 2016;352:i717. doi:http://dx.doi.org/10.1136/bmj.i717.