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Naftali Stern, Yona Greenman, Eldad Kisch, Galina Shenkerman, Michael Koffler, Itzchak Shapira, Esther Osher, O-52: Attempted lowering of blood pressure to less than 130/85 mm Hg in type 2 diabetic hypertensive patients: The diastolic cost, American Journal of Hypertension, Volume 14, Issue S1, April 2001, Page 24A, https://doi.org/10.1016/S0895-7061(01)01369-3
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Abstract
The practicality of attaining currently recommended target levels of less than 130/85 mm Hg in hypertensive type 2 diabetic patients remains to be shown, particularly in middle aged and older individuals. We systematically implemented JNC-VI guidelines (target < 130/85 mm Hg) in 257 type 2 diabetic hypertensive patients treated for hypertension at our clinic. Results: Goal diastolic pressure was achieved in 90% of the patients, but target systolic pressure in only 33%. In 57% (146/257) of the patients, the attained diastolic pressure was < 70 mm Hg (mean 66±1 mm Hg) and in one fifth of the cohort (53/257) diastolic pressure was reduced to < 70 mm Hg (mean of 60±0.5 mm Hg). Patients with final diastolic pressure < 70 mm Hg were older (70±1 vs. 64±2 yrs; p < 0.002), had a higher prevalence of preexisting coronary artery disease (52% vs. 28%; p < 0.01) and higher initial systolic pressure (166±4 v s. 156±2 mm Hg; p < 0.02) and pulse pressure (80±3 vs. 67.5±2 mm Hg p < 0.01) compared with patients whose final diastolic pressure was 71-84 mm Hg. Conclusions 1) Goal diastolic blood pressure for type 2 diabetic patients is easier to meet than goal systolic pressure. 2) Attempted lowering of blood pressure to target levels of less than 130/85 mm Hg is associated with inordinate lowering of diastolic pressure in a significant number of type 2 diabetic patients. Whether or not the benefits of attempted tight lowering of systolic pressure in type 2 diabetes outweigh the risk of excessive reduction of diastolic pressure remains to be determined.
