Attempted forced titration of blood pressure to <130/85 mm Hg in type 2 diabetic hypertensive patients in clinical practice: the diastolic cost.
The authors assessed the practicality and results of forced titrating of blood pressure to <130/85 mm Hg based on guidelines of the sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in the setting of a clinical practice in 257 diabetic, hypertensive patients. Goal diastolic pressure was achieved in 90% of the patients, but goal systolic pressure was achieved in only 33%. In 57% of the patients, the attained diastolic pressure was < or =70 mm Hg, and in 20% of the cohort diastolic pressure was reduced to <70 mm Hg (mean, 60+/-1 mm Hg). Patients with final diastolic pressure <70 mm Hg were older, had a higher prevalence of coronary artery disease, and higher initial systolic and pulse pressures compared with patients with final diastolic pressure of 71-85 mm Hg. Thus, attempted lowering of blood pressure to <130/85 mm Hg is associated with excessive lowering of diastolic pressure in a significant number of patients. Whether the benefits of tight systolic control outweigh the risks of excessive diastolic reduction requires further prospective assessment.
Osher
Esther
E
Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Greenman
Yona
Y
Tordjman
Karen
K
Kisch
Eldad
E
Shenkerman
Galina
G
Koffler
Michael
M
Shapira
Itzhak
I
Stern
Naftali
N
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013599:Systole; D016896:Treatment Outcome
D000959:Antihypertensive Agents