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In type 2 diabetes, consider disease burden when managing blood pressure

BOSTON — In this video exclusive, Vivian A. Fonseca, MD, FRCP, professor of medicine, chief of endocrinology and assistant dean for clinical research at Tulane University School of Medicine, discusses the challenges in managing blood pressure in patients with type 2 diabetes.

Several years ago, the American Diabetes Association recommended treating to a systolic BP target of less than 130 mm Hg, but that goal was relaxed after findings from the ACCORD trial demonstrated an increased risk for CV events in adults with type 2 diabetes treated to a target of less than 120 mm Hg, Fonseca said. More recently, the SPRINT trial demonstrated that treating to a systolic BP target of less than 120 mm Hg led to a significant reduction in CV events in people without diabetes.

“So, it becomes somewhat controversial as to whether we can apply those results to people with diabetes, when in the ACCORD study it didn’t work,” Fonseca said. “I think we need to look at it in the context of in whom these trials were done. The ACCORD study population had much more advanced cardiovascular disease, where it may have been too late to change the natural course of the disease.”

For most people with type 2 diabetes, Fonseca said, treating to a systolic BP target of less than 130 mm Hg is “very doable” with currently available medications. For some patients, such as those with diabetic kidney disease, even more aggressive management may be necessary, he said.

BOSTON — In this video exclusive, Vivian A. Fonseca, MD, FRCP, professor of medicine, chief of endocrinology and assistant dean for clinical research at Tulane University School of Medicine, discusses the challenges in managing blood pressure in patients with type 2 diabetes.

Several years ago, the American Diabetes Association recommended treating to a systolic BP target of less than 130 mm Hg, but that goal was relaxed after findings from the ACCORD trial demonstrated an increased risk for CV events in adults with type 2 diabetes treated to a target of less than 120 mm Hg, Fonseca said. More recently, the SPRINT trial demonstrated that treating to a systolic BP target of less than 120 mm Hg led to a significant reduction in CV events in people without diabetes.

“So, it becomes somewhat controversial as to whether we can apply those results to people with diabetes, when in the ACCORD study it didn’t work,” Fonseca said. “I think we need to look at it in the context of in whom these trials were done. The ACCORD study population had much more advanced cardiovascular disease, where it may have been too late to change the natural course of the disease.”

For most people with type 2 diabetes, Fonseca said, treating to a systolic BP target of less than 130 mm Hg is “very doable” with currently available medications. For some patients, such as those with diabetic kidney disease, even more aggressive management may be necessary, he said.

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