Evidence for and Against ACC/AHA 2017 Guideline for Target Systolic Blood Pressure of < 130mmHg in Persons with Type 2 Diabetes.

Abstract

We summarize the evidence for and against a target systolic blood pressure (SBP) < 130mmHg in individuals with type 2 diabetes mellitus (T2DM). The primary ACCORD trial pooled data from patients with more- and less-intense glycemic control and found no benefit to lowering SBP < 140mmHg, findings consistent with multiple meta-analyses. However, a re-analysis of the ACCORD trial found that participants randomized to less-intense glycemic control (HbA1c 7.0-7.9%) benefited from targeting SBP < 120 vs. 140mmHg. The SPRINT trial also found benefit for targeting SBP < 120 vs. 140mmHg in participants at risk for cardiovascular events but excluded persons with T2DM. There is no consensus as to the optimal SBP target for patients with T2DM, though data suggest a benefit to targeting SBP < 130mmHg in patients with less-intensive glucose control. Further research is also needed on BP control in the setting of newer anti-diabetic agents.