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Cohort study
Lower blood pressure associated with higher mortality in retrospective study of patients with newly diagnosed type 2 diabetes
  1. Richard W Grant1,
  2. Deborah J Wexler2
  1. 1Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
  2. 2Diabetes Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to: Dr Richard W Grant
    Division of Research, Kaiser Permanente Northern California,  2101 Webster, Oakland, CA 93452, USA; richard.w.grant{at}kp.org

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Commentary on Vamos EP, Harris M, Millett C, et al. Association of systolic and diastolic blood pressure and all cause mortality in people with newly diagnosed type 2 diabetes: retrospective cohort study. BMJ 2012;345:e5567

Context

Cardiovascular disease (CVD) is the leading cause of death in type 2 diabetes, which has led to increased focus on CVD risk reduction for patients with diabetes that emphasises blood pressure and cholesterol control.1 For most patients, clinical trial evidence supports treatment up to <140/90 mm Hg. In patients with increased CVD risk, such as the additional risk conferred by diabetes, the recommendation has been to treat up to <130/80 mm Hg, with the rationale that lower was better (which has proven more or less true for low-density lipoprotein (LDL lowering)). However, treatment at lower blood pressure levels is not without risk, particularly in older patients and those with multiple concurrent conditions, thus careful consideration of treatment …

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