A subset of the major United Kingdom Prospective Diabetes Study looked at the impact of improved blood pressure control on risks of cardiovascular disease in people with diabetes. Interestingly, the researchers found that lowering blood pressure was even more significant in reducing risk than lowering blood glucose levels in these individuals. The prevalence of hypertension in people with type 2 diabetes is twice that in the general population.

Earlier studies had also suggested that blood pressure was a stronger risk factor than glucose levels. For every 10 mmHg increase in blood pressure, the risk for cardiac events increased 15%; the risk increased 11% for each 1% increase in HbA1c.

In the UK subset, tight control of blood pressure (with a goal of 150/85 mmHg) was compared with less tight control (aiming for 180/105 mmHg). After 9 years, those in the tight control group demonstrated a significant reduction for most of the endpoints studied, including diabetes-related death, fatal and non-fatal stroke, heart failure, and microvascular complications (mainly retinopathy).

The authors concluded that tight control of blood pressure in people with diabetes:

• reduces the rate of deterioration in visual acuity
• reduces the risk of heart attack by 21%
• reduces all-cause mortality by 18%

The researchers suggest target blood pressure values of 130 - 140 mmHg systolic and 80 - 85 mmHg diastolic in order to realize these benefits. They also noted that combinations of antihypertensive medications are frequently needed and agents from different antihypertensive classes are useful.

Related information Heart disease and diabetes | Hypertension channel