Blood Pressure Control, Diabetes and Coronary Artery Disease Studied

People with hypertension, diabetes, and coronary artery disease who kept their systolic blood pressure lower than 130 millimeters of mercury (mm Hg) did not have better cardiovascular outcomes than those individuals with usual blood pressure control, according to a new study.

The research shows that people with type 2 diabetes and heart disease who were careful to keep blood pressure low did not avoid stroke and heart attacks any better than those with a higher blood pressure reading.

A study in the Journal of the American Medical Association (JAMA) points out that study participants with lower blood pressure actually were more likely to have a heart attack or stroke or die when their blood pressure was maintained under 130 mm Hg.

This finding is compared to patients with typical blood pressure control, putting them in the 130 to 140 mm Hg range. In healthy adults, blood pressure levels of 120/80 mm Hg or lower are recommended.

Fine-Tuning Best Approach for Patients

Rhonda Cooper-DeHoff, Pharm.D., M.S., lead author of the study, says the findings suggest that "lowering blood pressure intensively does not provide any benefit over and above usual blood pressure reduction.” Dr. Cooper-DeHoff is an associate professor at the University of Florida.

She notes that time would be better spent focusing on other heart disease risk factors that can be changed, such as cholesterol or weight.

Some organizations, including the American Diabetes Association, currently recommend that people with diabetes keep their blood pressure under 130/80 mm Hg, but it has been less clear what to recommend for patients with type 2 diabetes plus coronary artery disease.

To this end, the researchers studied data on 6,400 study participants with type 2 diabetes who were age 50 or over and who also had coronary artery disease.

&The participants were part of a larger clinical trial looking at whether certain medication regimens were better than others for preventing heart attacks and other long-term heart problems.

Risk Was Greatest with Very Low Blood Pressure

Volunteers were divided into groups – they received treatment with either a calcium antagonist or beta-blocker followed by angiotensin-converting enzyme inhibitor (ACE inhibitor), a diuretic, or both. The goal was to reach blood pressure levels of 130/85 mm Hg.

Individuals who had blood pressure between 130 mm Hg and 140 mm Hg and those with less than 130 mm Hg had roughly the same rate of cardiovascular events.

And, the results showed that participants with systolic blood pressure under 120 had a 15 percent higher risk of dying than those with the higher blood pressure readings.

Dr. Cooper-DeHoff says at this time there is no compelling evidence to show that lowering systolic blood pressure below 130 mm Hg is beneficial for patients with diabetes.

She suggests that the emphasis should be placed on maintaining systolic blood pressure between 130 and 139 mm Hg while focusing on efforts such as weight loss and healthful eating.

"We don't need to push below 130 so maybe we save a blood pressure medication and save some of those adverse effects associated with extra [blood pressure] medication and concentrate on some other goals that are still important in patients with diabetes," says Dr. Cooper-DeHoff.

Always consult your physician or other healthcare provider for more information.