title: The ideal blood pressure target to prevent cardiovascular disease in type 2 diabetes: a neutral viewpoint.
abstract: Type 2 diabetes mellitus (T2DM) and essential hypertension are often associated, and retrospective data analyses suggest an association between lower blood pressure (BP) values and lower cardiovascular (CV) risk in patients with T2DM. However, the most recent intervention trials fail to demonstrate a further CV risk reduction, for BP levels <130/80 mm Hg, when compared to levels <140/90 mm Hg. Moreover, a J-shaped, rather than a linear, relationship of BP reduction with incident CV events has been strongly suggested. We here debate the main available evidences for and against the concept of 'the lower the better', in the light of the main intervention trials and meta-analyses, with a particular emphasis on the targets to be pursued in elderly patients. Finally, the most recent guidelines of the scientific societies are critically discussed.
authors.affiliation: Department of Systems Medicine, University of Rome Tor Vergata - AFAR, Fatebenefratelli Hospital, Rome, Italy. Electronic address: frontoni@uniroma2.it.
authors.forename: S
authors.initials: S
authors.lastname: Frontoni
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Solini
authors.affiliation: Department of Medicine, University of Padova, Padova, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Fioretto
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Natali
authors.affiliation: Nephrology Dialysis Unit, Civil Hospital Imola, Imola, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Zuccalà
authors.affiliation: Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cosentino
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Disease, University of Pisa, Pisa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Penno
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications / Q000188:drug therapy; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D016903:Drug Monitoring; D019317:Evidence-Based Medicine; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007390:International Agencies; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012307:Risk Factors; D012955:Societies, Medical; D012958:Societies, Scientific; D014837:Voluntary Health Agencies
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers
keywords: Anti-hypertensive treatment; Blood pressure target; Elderly; J-shaped curve; Type 2 diabetes