title: Tight blood pressure control in diabetes: evidence-based review of treatment targets in patients with diabetes.
abstract: Blood pressure (BP) targets in diabetic patients stills represent the object of a major debate, fueled by the recent publication of post hoc observational analyses of the INVEST and the ONTARGET trials, suggesting an increased risk of cardiovascular events with tighter control, the J-curve effect, and by the results of the ACCORD trial, showing no improvements in the composite primary outcome of nonfatal myocardial infarction, stroke, or cardiovascular death in the intensive BP-lowering arm (<120/80 mmHg). In the present review, we focus on existing evidence about different BP targets in diabetic subjects and we present the results of our recent meta-analysis, showing that tight BP control may significantly reduce the risk of stroke in these patients without increasing the risk of myocardial infarction. Therapeutic inertia (leaving diabetic patients with BP values of 140/90 mmHg or higher) should be avoided at all costs, as this would lead to an unacceptable toll in terms of human lives, suffering, and socioeconomic costs.
authors.affiliation: Department of Internal Medicine, University of Perugia, Via E. Dal Pozzo, 06126 Perugia, Italy. paolo@unipg.it
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gentile
authors.forename: Valeria Maria
authors.initials: VM
authors.lastname: Manfreda
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D015201:Meta-Analysis as Topic; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents