T2D: intensive systolic BP reduction yields benefits even with low diastolic BP

  • Ilkun OL & al.
  • Diabetes Care
  • 4 May 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In people with type 2 diabetes (T2D), intensive reductions in systolic BP (SBP) are linked to decreased risk for a cardiovascular disease (CVD) composite endpoint.
  • Benefit is seen regardless of baseline diastolic BP (DBP) with standard glycemia, although risk increases slightly with low DBP and intensive glycemic control.

Why this matters

  • In T2D, low DBP has been linked to worse CVD outcomes, leaving the safety of pushing SBP to

Study design

Key results

  • Intensive SBP reductions were associated with decreased CVD composite risk (HR; 95% CI) with standard glycemic control: 
    • 0.76 (0.59-0.98).
  • Reduction was not seen with intensive glycemic control:
    • 1.06 (0.81-1.40).
  • The effect of SBP intervention on CVD outcome was not related to baseline DBP with either standard glycemia (P=.67) or intensive glycemia (P=.85).
  • Intensive SBP intervention and baseline DBP showed similar associations for CVD composite risk between the 2 glycemic control groups (3-way interaction P=.83).
  • In the intensive glycemia group, all-cause-mortality risk (HR; 95% CIs) with intensive SBP lowering, by baseline DBP:
    • ≤70 mmHg: 1.93 (1.18-3.14).
    • >70 mmHg: 0.99 (0.64-1.53).

Limitations

  • Post hoc.