Eduardo Sanchez, M.D., M.P.H., Chief Medical Officer for Prevention and Chief of the Center for Health Metrics and Evaluation, American Heart Association
Intensive blood pressure treatment is good for adults with type 2 diabetes, regardless of their baseline blood pressure or cardiovascular risk.
That’s the promising finding of a new study published today in the American Heart Association journal Hypertension.
Researchers analyzed nearly 11,000 adults in the ADVANCE study, a multicenter, randomized controlled trial of patients with type 2 diabetes and a history of cardiovascular disease or at least one CVD risk factor. They sought to know if baseline blood pressure category or CVD risk level modified the outcomes of intensive blood pressure treatment, compared with a placebo.
They found that the blood pressure treatment reduced all-cause mortality and major vascular events (which included cardiovascular death, non-fatal heart attacks and strokes, and onset or worsening of diabetes-related kidney or retinal disease) regardless of baseline blood pressure (evaluated down to <120 mm Hg systolic and <70 mm Hg diastolic) or 10-year atherosclerotic CVD risk (≥20% or <20%). The benefits from the blood pressure treatment were observed even at baseline blood pressure and CVD risk levels that some guidelines don’t currently recommend for intervention.
These results support the 2017 American College of Cardiology/American Heart Association blood pressure guidelines that recommend antihypertensive drug treatment be initiated at ≥130/80 mm Hg for adults with diabetes (with a treatment goal of <130/80 mm Hg).
Hypertension, diabetes, and mortality
- Ninety to 95% of people with diabetes in the United States have type 2 diabetes.
- About 70-80% of people with type 2 diabetes have hypertension, which increases their risk of heart attack, stroke, heart failure and all-cause mortality.
- People with diabetes are two times more likely to develop and die from cardiovascular disease.
As we consider the task of resuming the remarkable, decades-long decline in mortality from coronary heart disease and stroke in the United States (with some variability by race and ethnicity), improved blood pressure control in the millions of people with type 2 diabetes could save lives and get us back on track. This new study makes a strong case that people with diabetes, at moderate to high ASCVD risk, would benefit from intensive blood pressure treatment by reducing their risk of major vascular events and death from all causes.
Doing more to promote cardiovascular health
The increasing prevalence of type 2 diabetes among U.S. adults is driven by increases in overweight and obesity. This highlights the need for both primordial prevention (preventing the development of disease risk factors) and primary prevention (modifying existing risk factors to prevent development of disease), as described in the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease.
Educating people about lifestyle behaviors that influence healthy eating and physical activity is important, but we need to do more than educate – we need to activate people. This means that the broader systemic factors that influence weight must be harnessed. Policy, systems, and environmental changes can support and facilitate healthy weight efforts and support equitable approaches to promote population-wide energy balance.
The more of these changes we make, the more we can push the cardiovascular mortality curve back in the right direction and achieve longer, healthier lives. Improved cardiovascular health, including more people at healthy weight, might reduce the prevalence of type 2 diabetes and the need to intensively control the high blood pressure that often goes along with it.