Lowering Blood Pressure Reduces Complications in Diabetes

Prof. KAZEM RAHIMI | DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford Deputy Director, The George Institute for Global Health James Martin Fellow in Healthcare Innovation, Oxford Martin School Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School | University of Oxford Oxford United KingdomMedicalResearch.com Interview with:
Prof. Kazem Rahimi 
DM MSc FESC
Associate Professor of Cardiovascular Medicine, University of Oxford ;Deputy Director, The George Institute for Global Health; James Martin Fellow in Healthcare Innovation, Oxford Martin School; Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School United Kingdom

Medical Research: What is the background for this study? What are the main findings?

Dr. Rahimi: Lowering blood pressure (BP) in individuals with diabetes is an area of current controversy. Although it is widely accepted that lowering blood pressure in people with diabetes and elevated blood pressure will reduce the risk of heart and circulatory problems, it is less certain whether diabetics whose blood pressure is not very high should be treated with blood pressure lowering drugs, and how far their blood pressure should be reduced. It is also less well known how blood pressure lowering affects a range of other potential health complications for diabetes patients, such as diabetic eye disease.

We found that each 10-mm Hg lower systolic blood pressure led to a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria (the presence of excessive protein in the urine), and retinopathy (loss of vision related to diabetes). Although proportional effects of blood pressure lowering treatment for most outcomes studied were diminished below a systolic BP level of 140 mm Hg, data indicated that further reduction below 140 mm Hg led to a lower risk of stroke, retinopathy, and albuminuria, potentially leading to net benefits for many individuals at high risk for those outcomes.


Medical Research: What should clinicians and patients take away from your report?

Dr. Rahimi: In people with diabetes, blood pressure lowering medications reduce the risk of stroke and other vascular problems even when initial blood pressure levels are not very high. Hence,blood pressure lowering treatment should not be withheld from diabetes patients with blood pressure levels below 140 mmHg. Treatment decisions in such people, however, will need a more careful assessment of patient’s likely absolute net benefit.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Rahimi: Large-scale studies, including individual patient data meta-analyses, are needed to assess the balance of benefits and harms in more detail.

Citation:

 

Prof. KAZEM RAHIMI | DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford Deputy Director, The George Institute for Global Health James Martin Fellow in Healthcare Innovation, Oxford Martin School Honorary Consultant Cardiologi, & Prof. Kazem Rahimi DM MSc FESC (2015). Lowering Blood Pressure Reduces Complications in Diabetes MedicalResearch.com