8 Jul, 2010 in
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Study Suggests Guidelines Calling for Close Control May Need a Subordinate Look By Reviewed By July 6, 2010 — Close control of high blood pressure, recommended for those with diabetes by national guidelines, gives no best results than moderate control, according to a recent study. “The guidelines suggest you want diabetics to possess [systolic pressure] under 130,” says researcher Rhonda M. Cooper-DeHoff, PharmD, associate professor of pharmacy as well as medicine at the University of Florida, Gainesville. But in her study, those who kept their systolic pressures moderately controlled — at 130 to 139 — did as well as those who controlled it more tightly. Systolic pressure is the upper of the two blood pressure numbers, representing the maximum pressure exerted when the heart contracts. She compared ranges of blood pressure control on the effect on death, heart attack, as well as stroke during the follow-up. “There was no difference comparing those with close control or usual control,” she tells WebMD,” which is contrary to what the guidelines would suggest.” “The message is: we need to get diabetic patients’ systolic blood pressure to less than 140, particularly when they possess heart disease, but working to get it to less than 130 does not appear to add any additional benefit with regard to the risk of death, stroke, or heart attack,” Cooper-DeHoff says. The study is published in the Journal of the American Health examination Association. Close Control of Blood Pressure vs. Moderate ControlFor this study, Cooper-DeHoff as well as colleagues looked at a subgroup of 6,400 participants of a large study, called INVEST (International Verapamil SR-Trandolapril Study). It included more than 22,000 participants from 14 countries who were at least 50 years aged as well as had high blood pressure as well as coronary artery disease.
Study participants enrolled in the study from 1997 to 2000 as well as were followed through March 2003, with follow-up for U.S. participants extended through August 2008. For this analysis, the researchers focused only on the 6,400 who as well as had diabetes at the study start. INVEST compared two blood pressure lowering approaches, with participants given either a calcium antagonist medication earliest or a beta-blocker medication, followed by more drugs incase needed to lower pressure. Next, the researchers categorized the 6,400 participants into three groups:
Moderate Control of Blood Pressure Wins OutDuring the follow-up, researchers looked to see which of the groups categorized by the amount of control were more likely to die from any cause or to possess a heart attack or a stroke. Little difference was found between the close control as well as moderate control groups. Of the 6,400:
During the extended follow-up period, the risk of death from any cause was actually higher in the close control group, 22.8%, vs. those in the moderate control group, 21.8%. Cooper-DeHoff cautions that the results can’t be generalized to those who possess diabetes but not coronary artery disease. Even though the guidelines recommending lower blood pressures in those with diabetes possess been in place for nearly 20 years, she writes, “there is a paucity of evidence supporting this recommendation, particularly for lower systolic blood pressure.” Cooper-DeHoff reports receiving research funds from Abbott Laboratories, which makes blood-pressure-lowering drugs. Subordinate Opinion“This is pleasant news all the way around,” says P.K. Shah, MD, a cardiologist as well as director of the division of cardiology at the Cedars-Sinai Heart Institute, Cedars-Sinai Health examination Center, Los Angeles, who reviewed the study findings for WebMD. The take-home message for those similar the participants, he says, is that moderate blood pressure control is a reasonable range to shoot for. “This is saying moderate control of blood pressure is effective.” Other research finds that those with naturally abridged blood pressure are at reduced risk for problems such as heart attack as well as stroke, Shah says. “But drug-induced lowering [of blood pressure] isn’t the alike as common abridged blood pressure,” he says, explaining that blood pressure lowering by drugs does not mimic all the pleasant effects of having naturally abridged pressure. SOURCES: Rhonda Cooper-DeHoff, PharmD, associate professor of pharmacy as well as medicine, University of Florida, Gainesville. |
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