Table 1 Meta-analyses of anti-hypertensive treatment in diabetic patients
Topic | Year | Journal | Number of studies included | Number of patients included | Number of diabetics | Mean follow-up (years) | Main conclusions |
|---|---|---|---|---|---|---|---|
Effect of antihypertensive treatment at different BP levels in patients with diabetes mellitus [47] | 2016 | British Medical Journal | 49 | 73,738 | Only diabetic, most type 2 | 3.7 | If BP was greater than 150Â mmHg, treatment reduced all-cause mortality, CV mortality, myocardial infarction, stroke and end stage renal disease. If baseline systolic BP was less than 140Â mmHg, further treatment increased the risk of CV mortality with a tendency towards an increased risk of all-cause mortality |
BP lowering for prevention of CV disease and death [49] | 2016 | The Lancet | 123 | 613,815 | NA | NA | Every 10Â mmHg reduction in systolic BP significantly reduced the risk of major CV disease events, coronary heart disease, stroke and heart failure which, in the populations studied, led to a significant 13% reduction in all-cause mortality. The effect on renal failure was not significant. Proportional risk reductions (per 10Â mmHg lower systolic BP) were noted in trials with higher mean baseline systolic BP and trials with lower mean baseline systolic BP. There was no clear evidence that proportional risk reductions in major CV disease differed by baseline disease history, except for diabetes and chronic kidney disease, for which smaller, but significant, risk reductions were detected |
BP targets for hypertension in people with diabetes mellitus [48] | 2013 | Cochrane Database systematic reviews | 5 | 7314 | 7134 | 4.5 | Reduction in incidence of stroke in intensive BP reduction compared with standard reduction, no effect on mortality, significant increase in other serious adverse events |
BP Targets in Subjects With Type 2 Diabetes Mellitus/Impaired Fasting Glucose [50] | 2011 | Circulation | 13 | 37,736 | All | 4.8 ± 1.3 | A systolic BP treatment goal of 130 to 135 mmHg is acceptable. However, with more aggressive goals (<130 mmHg), the risk of stroke continues to fall, but there is no benefit regarding the risk of other macrovascular or microvascular events, and the risk of serious adverse events even increased |
Effects of intensive BP reduction on myocardial infarction and stroke in diabetes [51] | 2011 | Journal of Hypertension | 31 | 73,913 | 159 | NA | Tighter BP control reduced the risk of stroke by 31% compared with less tight control, whereas the reduction in the risk of MI was not significant |