Context

Diabetic patients with hypertension represent a population with a very high risk of developing cardiovascular (CV) complications such as myocardial infarction, stroke or renal failure. In order to prevent the occurrence of these complications, both European and American guidelines for the management of hypertension in diabetes recommend to lower blood pressure (BP) to less than 130/80 mm Hg and to even lower targets if the patient has a proteinuria of >1 g/24 h.1 2 These recommendations are based on the assumption that there is no real threshold value for BP. Hence, the CV risk continues to decrease well into the normal range of BP values. Moreover, the results of several clinical trials such has the Hypertension Optimal Treatment (HOT) trial3 or the UK Prospective Diabetes Study (UKPDS)4 have shown that patients with a tighter BP control had reduced microvascular and macrovascular complications.

However, the recent results of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial have questioned the real CV benefits of a lower BP in diabetic patients.5 Moreover, one has to acknowledge that there are limited study data supporting the recommendation to lower systolic BP below 130 mm Hg. At last, a low BP might actually increase the risk of CV events in patients with coronary artery disease (CAD) if one believes in the J curve phenomenon. It is in this context that the investigators …