Antihypertensive treatment is associated with a reduced risk of mortality and cardiovascular disease (CVD) in people with diabetes mellitus and a systolic blood pressure (BP) >140 mm Hg; however, in people with diabetes mellitus and a systolic BP of <140 mm Hg, the same treatment is associated with an increased risk of cardiovascular death and has no observed benefit. This according to a meta-analysis of 49 trials and 73,738 participants, most of whom had type 2 diabetes. Researchers found:

• If baseline systolic BP was >150 mm Hg, antihypertensive treatment reduced the risk of all-cause mortality (RR=0.89), cardiovascular mortality (RR=0.75), myocardial infarction (RR=0.74), stroke (RR=0.77), and end stage renal disease (RR=0.82).

• If baseline systolic BP was 140 to 150 mm Hg, additional treatment reduced the risk of all-cause mortality (RR=0.87), myocardial infarction (RR=0.84), and heart failure (RR=0.80).

• If baseline systolic BP was <140 mm Hg, further treatment increased the risk of CV mortality (RR=1.15), with a tendency toward an increased risk of all-cause mortality (RR=1.05).

Citation: Brunström M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ. 2016;352:i717. doi:http://dx.doi.org/10.1136/bmj.i717.