title: Blood pressure reduction in diabetes: lessons from ACCORD, SPRINT and EMPA-REG OUTCOME.
abstract: In patients with diabetes mellitus, the presence of hypertension substantially increases the risk of cardiovascular events, and reductions in blood pressure (BP) can reduce cardiovascular morbidity and mortality. Following evidence from trials randomizing patients to diastolic BP levels, previous guidelines recommended an office BP target of <130/80 mmHg in individuals with diabetes mellitus. However, the evidence for this systolic BP (SBP) target was derived from observational studies. When the results of the ACCORD-BP study showed that those individuals with diabetes mellitus and a target BP of <120 mmHg had a cardiovascular risk that is similar to those with <140 mmHg, all guidelines returned to a recommended SBP of <140 mmHg. However, the ACCORD-BP trial was limited by the low number of cardiovascular events observed, whereas the mean SBP in the 'conventional' arm was 133 mmHg. The SPRINT study, showing cardiovascular benefits in hypertensive patients without diabetes mellitus randomized to SBP <120 mmHg versus those randomized to <140 mmHg, came in contrast with the ACCORD-BP, but a detailed evaluation reveals many similarities between the two trials. Finally, the EMPA-REG OUTCOME study, with impressive cardiovascular mortality reduction with empagliflozin, suggested that reduction of SBP to around 130 mmHg is safe and might explain part of these beneficial results. In this Review, we evaluate the implications of the ACCORD-BP, SPRINT and EMPA-REG OUTCOME trials and previous studies for the optimal BP target in diabetes mellitus.
authors.affiliation: Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital.
authors.forename: Pantelis A
authors.initials: PA
authors.lastname: Sarafidis
authors.affiliation: 2nd Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.|Department of Internal Medicine, Papageorgiou Hospital, 56429 Thessaloniki, Greece.
authors.forename: Antonios A
authors.initials: AA
authors.lastname: Lazaridis
authors.affiliation: Institute of Investigation and Hypertension Unit, Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Ruiz-Hurtado
authors.affiliation: Institute of Investigation and Hypertension Unit, Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain.|Department of Preventive Medicine and Public Health, Universidad Autonoma, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain.|School of Doctoral Studies and Research, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D005960:Glucosides / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001559:Benzhydryl Compounds; D005960:Glucosides; C570240:empagliflozin