Antihypertensives cut deaths in 'healthy' diabetes patients

GPs should consider prescribing antihypertensives to patients with type 2 diabetes even if their BP is within guidelines, a study recommends.

Prescription form: antihypertensive advice
Prescription form: antihypertensive advice

The meta-analysis found that lowering BP in people with diabetes reduced their chances of death, heart disease, stroke and diabetes-related vision loss.

NICE recommends that GPs should aim for a BP below 140/90 mmHg in people under 80.

But lowering systolic BP to 130mmHg could improve health and survival for diabetes patients, and reducing it further would lower rates of stroke and albuminuria, the study authors from the University of Oxford say.

They looked at 40 studies and assessed various antihypertensive treatments such as diuretics and ACE inhibitors. Reducing BP below 140mmHg did not affect rates of heart or kidney failure.

Lower than guidelines

In an accompanying editorial in JAMA, Dr Bryan Williams from University College London said: ‘These findings…lend support to current guideline recommendations to consider offering patients with type 2 diabetes antihypertensive therapy when their systolic BP is 140mmHg or greater, aiming for a target systolic BP toward 130mmHg but not usually lower than this.’

‘This conundrum highlights the problems with clinician overreliance on guidelines and guideline overdependence on an often, uncritical adoption of evidence, despite the limitations of the clinical trials.’

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