Intensive blood pressure control prevents strokes in diabetic patients with hypertension

Sphygmomanometer

What target, if any, should we aim for in treating hypertension in patients with type 2 diabetes?

Clinical question:

In type 2 diabetes with hypertension, is intensive treatment, compared with less intensive treatment, effective at reducing the risk of stroke, death or other cardiovascular events?

Intensive treatment was defined as a target maximum of 130 mm Hg systolic and 80 mm Hg diastolic blood pressure, whilst less intensive treatment was defined as an upper limit of 140-160 mm Hg systolic and 85-100 mm Hg diastolic.

The evidence:

The reviewers pooled the raw data from different individual studies into a meta-analysis.  They found that patients who were assigned to intensive blood pressure targets had a significantly lower risk of stroke than the groups assigned to less intensive targets.  The data on mortality and myocardial infarction were not statistically signficant.

Appraisal hints:

  • Was the literature search comprehensive enough?
  • Did the reviewers do enough to evaluate the quality of the individual trials?
  • How long were the trials?  Was it long enough for the outcomes to appear?
  • There is a lot of uncertainty around the precise benefit we would expect.  It may be that mortality and myocardial infarction were too rare in the included studies, and require more data to clarify any benefits.
  • Does the review address adverse events and side effects?

Reference:

McBrien K, Rabi DM, Campbell N, Barnieh L, Clement F, Hemmelgarn BR, Tonelli M, Leiter LA, Klarenbach SW, Manns BJ. Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis. Arch Intern Med. 2012 Aug 6:1-8. doi: 10.1001/archinternmed.2012.3147. [Epub ahead of print]

 

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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