treatment of hypertension in type 2 diabetes is of great importance

treatment of hypertension in type 2 diabetes is of great importance to avoid costly complications and human suffering. the risk of both micro- and macrovascular disease in the UKPDS (4 5 as well as several other intervention studies (6-9). Guidelines have so far advocated a treatment target blood pressure of <130/80 mmHg for patients with type 2 diabetes (10-12). However the 2009 European guidelines from the European Society of Hypertension (ESH) recommend that patients with diabetes lower their SBP well below 140 mmHg-without mentioning a specific lowest target (13)-against a background of the lower blood pressure goals (<130/80 mmHg) recommended for patients with diabetes which have never really been achieved in any solitary large trial and so are even more hardly ever gained in medical practice. This ESH suggestion was also predicated on the outcomes in some tests (14 15 and post hoc analyses of high-risk hypertensive patients (16 17 as in the Ramipril Global Endpoint Trial (ONTARGET) post hoc study (18 19 of high-risk patients (49% with a previous coronary heart disease [CHD] and 38% with diabetes) demonstrating a J-shaped risk curve with a nadir of around 130 mmHg for Baricitinib in-treatment SBP and all CVD outcomes except stroke. This underlines the value Baricitinib of some recently published randomized trials and observational studies that have performed further studies of the effect of various SBP levels on the risk for CVD and mortality (Table 1). Table 1 Summary of recent studies in patients with type 2 diabetes and hypertension ACCORD BLOOD PRESSURE STUDY The recent Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial (ACCORD-BP) (20) in 4 733 high-risk patients with type 2 diabetes (34% had previous CVD) analyzed two randomly selected groups-one group assigned to intensive therapy targeting SBP of <120 mmHg and another group on standard therapy targeting SBP of <140 mmHg. Mean SBP after 1 year was 119 mmHg and 134 mmHg respectively and mean follow-up was 4.7 years. The primary composite outcome was nonfatal myocardial infarction nonfatal stroke or death from cardiovascular causes. The study investigators found no significant difference between the two groups in risk for the primary outcome or in risk for total mortality with hazard ratios (HRs) for intensive therapy of 0.88 (95% CI 0.73-1.06; = 0.2) and 1.07 (0.85-1.35; = 0.5) respectively. However the risk for the prespecified secondary end point stroke was reduced with intensive therapy (0.59 [0.39-0.89]; = 0.01). Serious adverse events attributed to antihypertensive treatment occurred more frequently (< 0.001) in 77 of the 2 2 362 participants (3.3%) in the intensive-therapy group compared with 30 of 2 371 (1.3%) with standard therapy. INVEST The International Verapamil-Trandolapril Study (INVEST) was a randomized controlled trial in 22 500 patients Baricitinib with hypertension and coronary heart disease with the objective to compare the effects of treatment with verapamil-trandolapril or atenolol-hydrochlorothiazide on the risk for CVD (21). The primary outcome was first occurrence of all-cause mortality nonfatal myocardial infarction or stroke and the mean follow-up was 2.7 years. A post hoc observational subgroup follow-up analysis of 6 400 hypertensive patients with diabetes and CHD has recently been presented (22) showing higher risk for the primary end point with SBP ≥140 mmHg (outcome rate 19.8% adjusted HR 1.46 [95% CI 1.25-1.71]; < 0.001) and similar Rabbit Polyclonal to Src (phospho-Tyr529). risk with SBP <130 mmHg (outcome rate 12.7% 1.11 [0.93-1.32]; = 0.2) compared with usual control 130-139 mmHg as reference (outcome rate 12.6%). SWEDISH NATIONAL DIABETES REGISTER BLOOD PRESSURE STUDY The recently published observational study from Baricitinib the Swedish National Diabetes Register (NDR) of 12 677 patients with type 2 diabetes treated with antihypertensive drugs (23) analyzed the effect of SBP levels on risks for fatal/nonfatal CHD stroke and CVD when followed for 5 years from 2002 to 2007 after exclusion of patients with a history of heart failure. Risk curves of CHD and stroke increased progressively with higher baseline or updated mean SBP across 110-180 mmHg in a Cox regression model and no J-shaped risk curves were seen at low SBP levels in all patients or in two subgroups without (= 10 304 or with (= 2 373 a history of CVD. With updated suggest SBP 110-129 mmHg (suggest 123 mmHg) as research SBP ≥140 mmHg (suggest 152 mmHg) demonstrated modified HR 1.37 (95% CI 1.12-1.68) for CHD 1.86 (1.34-2.59) Baricitinib for stroke and 1.44 (1.21-1.72) for CVD (=.