Target Blood Pressure in Patients with Diabetes.

Kang,  Tae Soo; Park,  Sungha

doi:2018.19.1.7

J Korean Diabetes > Volume 19(1); 2018 > Article

Statement

The Journal of Korean Diabetes 2018;19(1):7-14.
DOI: https://doi.org/10.4093/jkd.2018.19.1.7 Published online April 13, 2018.

당뇨병 환자에게 적절한 목표 혈압

강태수, 박성하

Target Blood Pressure in Patients with Diabetes.

Tae Soo Kang, Sungha Park

¹Division of Cardiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.
²Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. shpark0530@yuhs.ac

Abstract

The recently published 2017 American College of Cardiology (ACC)/American Heart Association (AHA)/American Academy of Physician Assistants/Association of Black Cardiologists/American College of Preventive Medicine/American Geriatrics Society/American Pharmacists Association/American Society of Hypertension (ASH)/American Society for Preventive Cardiology/National Medical Association/Preventive Cardiovascular Nurses Association (2017 ACC/AHA/ASH guideline for short) lowered the threshold for diagnosis of hypertension from 140/90 mm Hg to 130/80 mm Hg. Also, the revised guideline recommends pharmacological treatment for all hypertensive patients with either previous cardiovascular disease or 10-year atherosclerotic cardiovascular disease (ASCVD) risk greater than 10%. Since most diabetic hypertensive patients have ASCVD risk greater than 10%, the guideline recommends that all diabetics with blood pressure (BP) above 130/80 mm Hg be treated both pharmacologically and with active lifestyle modification. Although the evidence suggests that intensive lowering of BP may be beneficial in diabetic patients, there is lack of evidence that pharmacologic treatment in subjects with baseline BP below 140 mm Hg is beneficial, with some studies suggesting actual potential for harm. Also, there are data to suggest a potential risk of increased risk of cardiovascular events and mortality in subjects whose diastolic BP (DBP) was lowered to below 60 mm Hg. As such, strict BP lowering may be beneficial if the target BP could be achieved without side effects such as orthostatic hypotension and decreased renal function. Also, lowering of DBP below 60 mm Hg should be avoided. Lastly, treatment should be started in subjects with baseline BP above 140/90 mm Hg until further evidence suggests otherwise.

Key Words: Cardiovascular disease, Diabetes, Hypertension