CardioExchange Archive

Target systolic blood pressure in people with diabetes should be below 130 mm Hg, according to current guidelines, although there are no data for diabetics who also have coronary artery disease (CAD). Now, a large post-hoc analysis from INVEST (International Verapamil SR-Trandolapril Study) has found no evidence of benefit for tight blood pressure control below 130 mm Hg in patients with diabetes and CAD. The INVEST investigators performed a subgroup analysis of 6,400 subjects who were older than 50 years of age and had diabetes and CAD. After almost 17,000 patient-years of follow-up, the rate of death, nonfatal MI, or nonfatal stroke was nearly identical in the group that achieved tight BP control (systolic BP, <130 mm Hg) and the group that achieved usual control (systolic BP, 130 mm Hg to <140 mm Hg): 12.7% and 12.6%, respectively. By comparison, subjects with uncontrolled hypertension (systolic BP, 140 mm Hg or higher) had a significantly higher rate of events, 19.8%. Researchers observed a trend toward increased mortality in the tight control group versus usual control group (11.0% vs. 10.2%, 95% CI=0.99-1.45, P=0.06); upon extended follow-up, the difference between the groups achieved statistical significance (22.8% vs. 21.8%, CI=1.01-1.32, P=0.04).

In their report in JAMA, the authors conclude: “At this time, there is no compelling evidence to indicate that lowering systolic BP below 130 mm Hg is beneficial for patients with diabetes; thus, emphasis should be placed on maintaining systolic BP between 130 and 139 mm Hg while focusing on weight loss, healthful eating, and other manifestations of cardiovascular morbidity to further reduce long-term cardiovascular risk.”