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High blood pressure is an important risk factor for cardiovascular complications such as heart attack and stroke, not to mention kidney disease. People with diabetes are especially prone to these problems, so it's no wonder that physicians often treat hypertension aggressively in these patients. The idea that keeping blood pressure under strict control would offer better results seems to make sense. But a new study shows it doesn't work.
In this research, 6,400 people with diabetes and coronary artery disease were followed for approximately 8 years. There was quite an important difference in outcomes between the group with usual control of blood pressure and those who could not get their blood pressure under control. Nearly 20 percent of the uncontrolled group experienced a serious event such as stroke, heart attack or death. In contrast, only 12.6 percent of those with usual blood pressure control and 12.7 percent of those with tight blood pressure control had such a harmful result. Obviously, controlling blood pressure is important for people with diabetes, but working extra hard to get it down to normal levels doesn't offer an additional benefit. This finding agrees with that of another large study that was reported recently, the ACCORD trial.
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Not enough info given about ACCORD trial to know details and know if the study was well designed and useful.
PEOPLE'S PHARMACY RESPONSE: IT WAS A LARGE, CAREFULLY DESIGNED TRIAL AND GOVERNMENT FUNDED. HERE ARE SOME OF THE ABSTRACTS:
http://www.ncbi.nlm.nih.gov/pubmed/20594588
http://www.ncbi.nlm.nih.gov/pubmed/20228404
http://www.ncbi.nlm.nih.gov/pubmed/20228401
I don't know what "tight" control is.
PEOPLE'S PHARMACY RESPONSE: TIGHT CONTROL MEANS GETTING BLOOD PRESSURE DOWN TO WHAT IT WOULD BE IF THE PERSON HAD NO HYPERTENSION, under 130 systolic.
Interesting study. Of note: It appears that the "tightly controlled" group were on the lowest doses of meds and were generally taking fewer meds than the "usual" and "uncontrolled" groups. Therefore aggressiveness of treatment was not the major factor. Unless I'm missing something, there must be some other factor at play here?
In the study, "tight" control was defined as people whose b/p was brought to less than 130 systolic. "Usual" control was 130-140 and "uncontrolled" were those over 140. This was an observational study--they didn't manipulate the treatments. They just observed what happened with people on various treatments.
Actually now I am more confused than ever!
JOHNB: I think it's a pretty confusing study to draw any conclusions about. But maybe someone will enlighten us...
PEOPLE'S PHARMACY RESPONSE: I THINK THE MESSAGE HERE IS THAT SOME BLOOD PRESSURE CONTROL IS CRITICAL. GETTING THE PRESSURE DOWN AS LOW AS POSSIBLE ISN'T WORTH THE TROUBLE.