Tight Blood Pressure Control and Cardiovascular Outcomes Among Hypertensive Patients With Diabetes and Coronary Artery Disease

Abstract

The 1984 report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recognized that patients with diabetes mellitus represented a special population.¹ In 1993, the fifth report of the Joint National Committee recommended that the treatment goal for patients with diabetes should reduce blood pressure (BP) to less than 130/85 mm Hg.² This lower goal was based primarily on data from the 1501-patient cohort with diabetes enrolled in the Hypertension Optimal Treatment (HOT) trial,³ which suggested reduced cardiovascular outcomes for 501 patients assigned to a diastolic treatment goal of less than 80 mm Hg compared with those assigned to treatment goals that allowed for higher BP. Data from the United Kingdom Prospective Diabetes Study (UKPDS) group^4,5 showed that patients with diabetes and hypertension assigned to a tight BP goal group had reduced macrovascular and microvascular outcomes. In 2002, the American Diabetes Association recommended that the BP treatment goal for patients with diabetes should be less than 130/80 mm Hg, which it reaffirmed in 2010.^6-8