Individualizing Blood Pressure Targets for People With Diabetes and Hypertension

Boer, Ian H. de; Bakris, George L.; Cannon, Christopher P.

doi:10.1001/jama.2018.0642

Cited by 51 publications

(31 citation statements)

References 12 publications

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“…In contrast to the SPRINT results, among patients with type 2 diabetes and hypertension (systolic BP $140/ 90 mm Hg), multiple clinical trials and meta-analyses show that pharmacologic lowering of BP also reduces cardiovascular events, including stroke, heart attack, and cardiovascular death (9). However, the results vary by population and study design.…”

Section: What Is the Evidence?mentioning

confidence: 75%

Defining Hypertension

Toto

2018

CJASN

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Section: What Is the Evidence?mentioning

confidence: 75%

Defining Hypertension

Toto

2018

CJASN

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“…whether to use resting office readings or 24h-assessment), is not universally agreed and guidelines differ in recommending target systolic and diastolic pressures. 5,11 Lower targets (e.g. <130/80 mmHg) are generally considered appropriate to reduce cardiovascular risk and slow eGFR-decline once albuminuria develops.…”

mentioning

confidence: 99%

New pharmacological strategies for protecting kidney function in type 2 diabetes

Muskiet

Wheeler

Heerspink

2019

The Lancet Diabetes & Endocrinology

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Diabetes is the leading cause of impaired kidney function, albuminuria and renal replacement therapy in virtually all regions of the world and places a large burden on health care systems. Current treatment strategies rely on intensive glucose-lowering and strict blood pressure control, targeting blockade of the renin-angiotensin-aldosterone system. Such approaches may slow decline in kidney function, but many patients progress to end-stage kidney failure despite optimal therapy. In recent clinical trials, two new-generation glucose-lowering drug classes; the sodium-glucose co-transporter (SGLT)2 inhibitors and glucagon-like peptide (GLP)-1 receptor agonists have been shown to improve both kidney and cardiovascular outcomes in patients with type 2 diabetes. Other new approaches, based on an improved understanding of the mechanisms that contribute kidney damage in the context of diabetes, include use of drugs that block endothelin receptors (e.g. atrasentan) and non-steroidal mineralocorticoid receptors (e.g. finerenone). Here we review recent clinical data relevant to these new therapeutic approaches in the management of kidney disease in the context of type 2 diabetes.

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“…Although ADA did not change the BP threshold/target for most of the patients with diabetes mellitus, 5 an individualized approach with a lower BP target (130/80 mm Hg) was recommended for patients at high risk of cardiovascular or kidney disease. 4,5 When this individualized approach was applied to the discordant population, 65.9% (95% CI, 62.8-68.8) would be eligible for a lower BP target (130/80 mm Hg) based on their high 10-year ASCVD risk or coexisting conditions (ASCVD or CKD).…”

Section: Discussionmentioning

confidence: 99%

“…4,5 When this individualized approach was applied to the discordant population, 65.9% (95% CI, 62.8-68.8) would be eligible for a lower BP target (130/80 mm Hg) based on their high 10-year ASCVD risk or coexisting conditions (ASCVD or CKD).…”

Section: Discussionmentioning

confidence: 99%

“…The authors of the ADA position statement emphasized the importance of an individualized approach to treat hypertension in patients with diabetes mellitus rather than changing the BP threshold. 5 Because of the difference between the 2 recommendations and lack of quality evidence to determine a precise BP threshold/target in patients with diabetes mellitus, 5 uncertainty still remains in this population. Because the clinical impact of this difference has never been studied, we investigated the prevalence and characteristics of diabetic patients with hypertension and discordant population in the United States according to the ACC/AHA and ADA recommendations.…”

mentioning

confidence: 99%

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