Trying to get blood pressure really low may not pay off. People with diabetes are at much higher risk of heart disease, so doctors often concentrate on treating their hypertension carefully. Some urge patients to get their blood pressure down to 120 over 80 or lower if possible.
Now a huge study dubbed the ACCORD trial shows that effort does not save lives or prevent heart attacks. Nearly 5,000 people with type 2 diabetes were assigned to standard care, with the goal of getting systolic blood pressure under 140, or to intensive therapy to get it to 120 or below.
The patients were followed up for more than 4.5 years, and the treatments were successful, by and large, at achieving their blood pressure targets. But the differences between the two groups with respect to heart attack or death were not significant, and there were more serious side effects among people on intensive treatment. Given these findings, it would be hard to argue that the benefits of lowering blood pressure to normal outweigh the downsides, even among people at high risk of cardiovascular complications because of their type 2 diabetes.
[New England Journal of Medicine, April 29, 2010]
The People's Perspective on Medicine