Forums » Open clinical » Diabetes » Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
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Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
posted at 26/8/2012 3:43 PM BST
on bmj.com
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes. Arch Intern Med. 2012 Aug 6:1-8. doi: 10.1001/archinternmed.2012.3147 BACKGROUND Treatment of hypertension in patients with diabetes mellitus (DM) has been shown to improve cardiovascular outcomes; however, the value of intensive blood pressure (BP) targets remains uncertain. We sought to determine the effectiveness and safety of treating BP to intensive targets (upper limit of 130 mm Hg systolic and 80 mm Hg diastolic) compared with standard targets (upper limit of 140-160 mm Hg systolic and 85-100 mm Hg diastolic) in patients with type 2 DM. METHODS Using electronic databases, bibliographies, and clinical trial registries, we conducted a systematic review and meta-analysis to identify randomized trials enrolling adults diagnosed as having type 2 DM and comparing prespecified BP targets. Data on study characteristics, risk for bias, and outcomes were collected. Random-effects models were used to pool relative risks and risk differences for mortality, myocardial infarction, and stroke. RESULTS The use of intensive BP targets was not associated with a significant decrease in the risk for mortality (relative risk difference, 0.76; 95% CI, 0.55-1.05) or myocardial infarction (relative risk difference, 0.93; 95% CI, 0.80-1.08) but was associated with a decrease in the risk for stroke (relative risk, 0.65; 95% CI, 0.48-0.86). The pooled analysis of risk differences associated with the use of intensive BP targets demonstrated a small absolute decrease in the risk for stroke (absolute risk difference, -0.01; 95% CI, -0.02 to -0.00) but no statistically significant difference in the risk for mortality or myocardial infarction. CONCLUSION Although the use of intensive compared with standard BP targets in patients with type 2 DM is associated with a small reduction in the risk for stroke, evidence does not show that intensive targets reduce the risk for mortality or myocardial infarction. COMMENT: There are too few studies in this analysis to come to any strong conclusions. As mentioned in the comments (http://journalwise.acponline.org/ArticleView.aspx?UI=47155) the ACCORD study had the came conclusions and essentially dominates this analysis. I still will use 130/80 as my goals in persons with diabetes monitoring orthostatic symptoms and renal function.
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Re: Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
posted at 26/8/2012 9:02 PM BST
on bmj.com
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Posts: 1786
First: 7/3/2009 Last: 22/5/2013 |
Here it is. I always thought that too much will not necessarily result in better outcome. I must also say that the current tendency to keep blood pressure as low as possible is probably not as great as we think. It's all in the delicate balance between what is optimal for perfusion of organs and what is optimal for the heart and the vasculature. And even more so we kind of forgot about age and many other variables.All these need to be taken into account and adjusted, so 130/80 or 120/80 are not "sacred" numbers. For some reason it is what I feel will be also true for the sometimes"crazy" LDL levels that are religiously reverred today. If after all those years, and current accumulating knowledge about the heterogeneity of populations and existing various polymorphisms, people still believe in one solution to all, then we are in trouble.
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Re: Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
posted at 26/8/2012 11:16 PM BST
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
I do agree with Yoram in that too much control will not necessarily result in better outcome. Also the optimal range varies with age. We should not try to control the blood pressure aggressively, as every person is 'tuned' with a different optimal level & the aggressive control would disturb the delicate balance between what is optimal for perfusion of organs and what is optimal for the heart and the vasculature. Especially in the 'stroke' patients, the rise in the blood pressure is a physiological response of the body to counteract the block & aggressive reduction in the blood pressure will worsen the condition. |
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Re: Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
posted at 27/8/2012 3:09 PM BST
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
Since the BMJ promotes evidence-based medicine I ask Dr. Chaiter and Ashutosh to cite studies that indicate that blood presure goals shoud be age related and different in post stroke patients. Here is my evidence from JNC 7 that they should not be. Bold added for emphysis. http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf Goals of Therapy The ultimate public health goal of antihypertensive therapy is the reduction of cardiovascular and renal morbidity and mortality. Since most persons with hypertension, especially those age >50 years, will reach the DBP goal once SBP is at goal, the primary focus should be on achieving the SBP goal. Treating SBP and DBP to targets that are <140/90 mmHg is associated with a decrease in CVD complications. In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mmHg.
Hypertension in older persons Hypertension occurs in more than two-thirds of individuals after age 65. This is also the population with the lowest rates of BP control. Treatment recommendations for older people with hypertension, including those who have isolated systolic hypertension, should follow the same principles outlined for the general care of hypertension. In many individuals, lower initial drug doses may be indicated to avoid symptoms; however, standard doses and multiple drugs are needed in the majority of older people to reach appropriate BP targets.
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Re: Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
posted at 27/8/2012 8:02 PM BST
on bmj.com
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Posts: 1786
First: 7/3/2009 Last: 22/5/2013 |
Here is some food for thought.The opinions vary but what I wanted to show is that the standard same goal to all is in question.1.Ann Med. 2012 Jun;44 Suppl 1:S36-42. Blood pressure treatment target in patients with diabetes mellitus--current evidence.SourceInstitute of Clinical Medicine/Internal Medicine, University of Oulu, Oulu, Finland. Noel.barengo@gmail.com AbstractHypertension is a very common cardiovascular disease (CVD) risk factor in diabetes, affecting more than half of diabetic patients. Major guidelines on the management of hypertension recommend to start antihypertensive drugs in all diabetic patients with a systolic blood pressure (SBP) 140 mmHg or more and/or a diastolic blood pressure (DBP) 90 mmHg or more, and to adjust the treatment strategy in order to lower their BP below these values. The present body of evidence suggests that in patients with type 2 diabetes mellitus/impaired fasting glucose/impaired glucose tolerance, a SBP treatment goal of 130 to 135 mmHg is acceptable. Aiming at SBP levels of 130 mmHg decreases stroke risk, but the risk of serious adverse events may increase with very low BP levels. The results regarding the attained DBP level is somewhat complex, since middle-aged people with diastolic hypertension and pre-existing CVD may have increased CVD mortality if their DBP is lowered drastically to a very low level. With the currently available very limited trial data on low attained BP level, it is not possible to set a specific treatment target regarding BP levels for diabetic hypertensive patients, but it is important to use a personalized approach in their antihypertensive treatment.
2.Ann N Y Acad Sci. 2012 Apr;1254:115-22. doi: 10.1111/j.1749-6632.2012.06489.x. Controversies in blood pressure goal guidelines and masked hypertension.SourceUniversity of Massachusetts Medical School, Worcester, Massachusetts, USA. Robert.Phillips@umassmemorial.org AbstractIn uncomplicated hypertension, <140/90 mmHg is the treatment goal for individuals aged 18-79 and between 140 mmHg and 150 mmHg in those 80 years of age. Inhibitors of the renin-angiotensin-aldosterone system, as well as calcium channel blockers, are universally accepted as first-line therapy in uncomplicated hypertension, but controversy exists over the role of thiazide diuretics and beta blockers. Because at similar blood pressure (BP) levels, African Americans have more target organ damage than whites, a lower goal of <135/85 mmHg is recommended. In patients with coronary artery disease, diabetes, and chronic kidney disease, <130/80 mmHg is recommended. Masked hypertension, defined as normal clinic BP with a high average self-monitored or ambulatory BP, is prevalent in those with chronic kidney disease, diabetes, and obstructive sleep apnea. Masked hypertension is associated with worse outcome. Ambulatory BP monitoring for those at risk for masked hypertension needs to be incorporated into guidelines.
3.Lancet Neurol. 2010 Aug;9(8):767-75. Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial.Robinson TG, Potter JF, Ford GA, Bulpitt CJ, Chernova J, Jagger C, James MA, Knight J, Markus HS, Mistri AK, Poulter NR; COSSACS Investigators. SourceDepartment of Cardiovascular Sciences, University of Leicester, University Hospitals of Leicester NHS Trust, Leicester, UK. tgr2@le.ac.uk AbstractBACKGROUND:Up to 50% of patients with acute stroke are taking antihypertensive drugs on hospital admission. However, whether such treatment should be continued during the immediate post-stroke period is unclear. We therefore aimed to assess the efficacy and safety of continuing or stopping pre-existing antihypertensive drugs in patients who had recently had a stroke. METHODS:The Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS) was a UK multicentre, prospective, randomised, open, blinded-endpoint trial. Patients were recruited at 49 UK National Institute for Health Research Stroke Research Network centres from January 1, 2003, to March 31, 2009. Patients aged over 18 years who were taking antihypertensive drugs were enrolled within 48 h of stroke and the last dose of antihypertensive drug. Patients were randomly assigned (1:1) by secure internet central randomisation to either continue or stop pre-existing antihypertensive drugs for 2 weeks. Patients and clinicians who randomly assigned patients were unmasked to group allocation. Clinicians who assessed 2-week outcomes and 6-month outcomes were masked to group allocation. The primary endpoint was death or dependency at 2 weeks, with dependency defined as a modified Rankin scale score greater than 3 points. Analysis was by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Register, number ISRCTN89712435. FINDINGS:763 patients were assigned to continue (n=379) or stop (n=384) pre-existing antihypertensive drugs. 72 of 379 patients in the continue group and 82 of 384 patients in the stop group reached the primary endpoint (relative risk 0.86, 95% CI 0.65-1.14; p=0.3). The difference in systolic blood pressure at 2 weeks between the continue group and the stop group was 13 mm Hg (95% CI 10-17) and the difference in diastolic blood pressure was 8 mm Hg (6-10; difference between groups p<0.0001). No substantial differences were observed between groups in rates of serious adverse events, 6-month mortality, or major cardiovascular events. INTERPRETATION:Continuation of antihypertensive drugs did not reduce 2-week death or dependency, cardiovascular event rate, or mortality at 6 months. Lower blood pressure levels in those who continued antihypertensive treatment after acute mild stroke were not associated with an increase in adverse events. These neutral results might be because COSSACS was underpowered owing to early termination of the trial, and support the continuation of ongoing research trials.
Management of hypertension in the elderly.SourceEndocrine Hypertension Research Centre and Clinical Centre of Research Excellence in Cardiovascular Disease and Metabolic Disorders, University of Queensland School of Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia. e.pimenta@uq.edu.au AbstractHypertension is the most-prevalent modifiable risk factor for cardiovascular morbidity and mortality worldwide. Hypertension is highly prevalent among older adults (≥65 years), and aging of the population will substantially increase the prevalence of this condition. Age-related endothelial dysfunction and increased arterial stiffness contribute to the increased prevalence of hypertension, particularly systolic hypertension, among the elderly. The incidence of some forms of secondary hypertension also increases with age, mainly owing to the use of drugs (especially NSAIDs that have pressor effects) and the presence of chronic kidney disease, obstructive sleep apnea, and renal artery stenosis. Guidelines differ in thresholds and goals for antihypertensive drug therapy in the elderly because of a paucity of high-level evidence from randomized controlled trials and inconsistencies in the definition of 'elderly'. Medical treatment of hypertension reduces cardiovascular morbidity and mortality in the elderly, and all guidelines recommend lifestyle modifications and medical treatment for elderly patients whose blood pressure exceeds prescribed thresholds and who are at moderate or high cardiovascular disease risk. In the absence of comorbidities, which constitute 'compelling indications' for the use of specific antihypertensive drugs or drug classes, no clear evidence exists to support recommendations for the use of particular antihypertensive-drug classes in older adults.
4.JAMA. 2010 Jul 7;304(1):61-8. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease.SourceDepartment of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine, College of Pharmacy, University of Florida, 1600 SW Archer Rd, PO Box 100486, Gainesville, FL 32610-0486, USA. dehoff@cop.ufl.edu AbstractCONTEXT:Hypertension guidelines advocate treating systolic blood pressure (BP) to less than 130 mm Hg for patients with diabetes mellitus; however, data are lacking for the growing population who also have coronary artery disease (CAD). OBJECTIVE:To determine the association of systolic BP control achieved and adverse cardiovascular outcomes in a cohort of patients with diabetes and CAD. DESIGN, SETTING, AND PATIENTS:Observational subgroup analysis of 6400 of the 22,576 participants in the International Verapamil SR-Trandolapril Study (INVEST). For this analysis, participants were at least 50 years old and had diabetes and CAD. Participants were recruited between September 1997 and December 2000 from 862 sites in 14 countries and were followed up through March 2003 with an extended follow-up through August 2008 through the National Death Index for US participants. INTERVENTION:Patients received first-line treatment of either a calcium antagonist or beta-blocker followed by angiotensin-converting enzyme inhibitor, a diuretic, or both to achieve systolic BP of less than 130 and diastolic BP of less than 85 mm Hg. Patients were categorized as having tight control if they could maintain their systolic BP at less than 130 mm Hg; usual control if it ranged from 130 mm Hg to less than 140 mm Hg; and uncontrolled if it was 140 mm Hg or higher. MAIN OUTCOME MEASURES:Adverse cardiovascular outcomes, including the primary outcomes which was the first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS:During 16,893 patient-years of follow-up, 286 patients (12.7%) who maintained tight control, 249 (12.6%) who had usual control, and 431 (19.8%) who had uncontrolled systolic BP experienced a primary outcome event. Patients in the usual-control group had a cardiovascular event rate of 12.6% vs a 19.8% event rate for those in the uncontrolled group (adjusted hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.25-1.71; P < .001). However, little difference existed between those with usual control and those with tight control. Their respective event rates were 12.6% vs 12.7% (adjusted HR, 1.11; 95% CI, 0.93-1.32; P = .24). The all-cause mortality rate was 11.0% in the tight-control group vs 10.2% in the usual-control group (adjusted HR, 1.20; 95% CI, 0.99-1.45; P = .06); however, when extended follow-up was included, risk of all-cause mortality was 22.8% in the tight control vs 21.8% in the usual control group (adjusted HR, 1.15; 95% CI, 1.01-1.32; P = .04). CONCLUSION:Tight control of systolic BP among patients with diabetes and CAD was not associated with improved cardiovascular outcomes compared with usual control.
5.Curr Opin Anaesthesiol. 2012 Aug 14. [Epub ahead of print] Blood pressure management in stroke.SourceaDepartment of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA bDepartment of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, J Pattison Pavilion North, Vancouver, British Columbia, Canada. AbstractPURPOSE OF REVIEW:Cerebrovascular disease is a common cause of death and disability worldwide. The current literature supports an association between blood pressure (BP) and patient outcome during acute stroke. This review will provide an overview of the evidence to guide BP management during acute stroke. RECENT FINDINGS:Hypotension and hypertension are correlated with poor outcome in acute ischemic stroke, but the effect of reducing or augmenting BP is unclear. In most cases, BP should be treated only when SBP is greater than 220 or greater than 180 in candidates for thrombolysis. There is a lack of evidence to support the choice of specific agents. Use of vasopressor drugs to treat hypotension in acute stroke should be limited to selective situations. In acute hemorrhagic stroke, SBP greater than 140 has been correlated with poor outcomes. Two recent studies report the safety and feasibility of early BP reduction in hemorrhagic stroke. SUMMARY:Both hypertension and hypotension are associated with worse outcomes during acute stroke; however, the optimal hemodynamic parameters are not clearly defined in this patient population. Despite active research, there is a lack of high-quality data guiding current BP management in stroke. Several trials currently underway may clarify the many existing questions on this topic.
6.Curr Opin Crit Care. 2012 Apr;18(2):132-8. Blood pressure control for acute ischemic and hemorrhagic stroke.SourceDepartment of Emergency Medicine and Division of Neurocritical Care, Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0769, USA. AbstractPURPOSE OF REVIEW:Acute stroke, including the subtypes of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), typically involves significant fluctuations in blood pressure (BP). Treatment of BP after all stroke types is controversial. In each case, there are theoretical dangers to leaving BP alone as well as altering it artificially. In this article, we review the role of BP in each stroke subtype and the existing evidence for BP optimization. RECENT FINDINGS:Except in patients receiving thrombolytic therapy, there is insufficient evidence to recommend active BP management in ischemic stroke. In ICH, the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) trial and Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) have demonstrated that systolic BP reduction to 140 mmHg is well tolerated and associated with attenuation of hematoma expansion. The impact of BP reduction on outcomes is being evaluated in the ongoing phase III ATACH II and INTERACT 2 trials. No evidence exists to recommend definitive BP management strategies in acute SAH, although hypertension should likely be avoided before an aneurysm is secured, and hypotension should be avoided altogether. SUMMARY:Evidence for BP management in acute stroke is limited, although large randomized trials are currently in progress for both ischemic stroke and ICH. BP management in SAH remains woefully understudied.
7.J Clin Hypertens (Greenwich). 2012 Aug;14(8):537-46. doi: 10.1111/j.1751-7176.2012.00638.x. Epub 2012 May 14. Prognostic impact of baseline low blood pressure in hypertensive patients with stable coronary artery disease of daily clinical practice.SourceFrom the Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain. AbstractJ Clin Hypertens (Greenwich). 2012;00:00-00 ©2012 Wiley Periodicals, Inc. The authors' aim was to investigate the prognostic value of first-visit systolic and diastolic blood pressure (SBP/DBP) in hypertensive patients with stable coronary artery disease (sCAD) in conditions of contemporary daily clinical practice. From February 1, 2000, to January 31, 2004, 690 consecutive hypertensive patients with sCAD (mean age 68±10 years, 65% male) were prospectively followed in the outpatient cardiology clinic for major events (acute coronary syndrome, revascularization, stroke, heart failure, or death) and associations with baseline SBP/DBP were investigated. At first visit, median SBP/SDP were 130/75 mm Hg (interquartile range, 25-75; 120-140/70-80 mm Hg). After 25 months of follow-up (median), 19 patients died (2.8%); 10 from cardiovascular causes (1.5%), 87 patients experienced a coronary event (13%), and 130 patients (19%) a major event. After adjusting for baseline variables, DBP <75 mm Hg or SBP <130 mm Hg resulted in independent predictors of major events (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.07-2.16, P=.02; HR, 1.68; 95% CI, 1.18-2.40, P=.004, respectively), coronary events (HR, 1.78; 95% CI, 1.15-2.75, P=.009; HR, 1.84; 95% CI, 1.20-2.83, P=.005, respectively), and cardiovascular mortality (HR, 7.02; 95% CI, 1.26-39.04, P=.03; HR, 9.26; 95% CI, 1.33-64.32, P=.02, respectively). In this study, a low first-visit SBP or DBP was associated with an adverse prognosis in hypertensive patients with sCAD of contemporary daily clinical practice
8.J Stroke Cerebrovasc Dis. 2012 Jan 12. [Epub ahead of print] Low-Normal Systolic Blood Pressure and Secondary Stroke Risk.SourceDepartment of Neurosciences, University of California, San Diego, California. AbstractA recent observational study of >20,000 patients with recent ischemic stroke suggested that systolic blood pressure (SBP) maintained in a low-normal range may be associated with increased risk of recurrent stroke, especially within the first 6 months after the first stroke. Using a distinct cohort, the current study aimed to independently evaluate the relationship between low-normal SBP levels and risk of recurrent stroke through analysis of a trial dataset involving 3680 patients with recent noncardioembolic ischemic stroke aged ≥35 years recruited from 56 centers between September 1996 and May 2003 and followed for 2 years. Subjects were categorized based on their mean in-trial SBP value as low-normal (<120 mm Hg), high-normal (120 to <140 mm Hg), or high (>140 mm Hg). The primary outcome was stroke. Multivariate analyses used competing-risks Cox regression models. The rate of recurrent stroke was 9.1% in the low-normal group, 6.7% in the high-normal group, and 10% in the high group. The difference in recurrent stroke rate between the low-normal and high-normal groups was more prominent within the first 6 months (low-normal, 4.5%; high-normal, 2.5%; high, 3.4%) than after 6 months (low-normal, 4.6%; high-normal, 4.2%; high, 6.6%). Over the study period, compared with the high-normal group, the risk of the primary outcome trended higher in the low-normal group (adjusted hazard ratio, 1.47; 95% confidence interval, 0.94-2.29; P = .09) and was higher in the high group (adjusted hazard ratio, 1.39; 95% confidence interval, 1.08-1.79; P = .01). These results support the recently described pattern of increased risk of recurrent stroke in patients with low-normal SBP levels, especially within the first 6 months after first stroke. However, this study likely was not sufficiently powered to detect more than a strong statistical trend underlying this relationship.
9.JAMA. 2011 Nov 16;306(19):2137-44. Level of systolic blood pressure within the normal range and risk of recurrent stroke.Ovbiagele B, Diener HC, Yusuf S, Martin RH, Cotton D, Vinisko R, Donnan GA, Bath PM; PROFESS Investigators. SourceDepartment of Neurosciences, University of California, 9500 Gilman Dr, San Diego, CA 92093, USA. Ovibes@ucsd.edu AbstractCONTEXT:Recurrent stroke prevention guidelines suggest that larger reductions in systolic blood pressure (SBP) are positively associated with a greater reduction in the risk of recurrent stroke and define an SBP level of less than 120 mm Hg as normal. However, the association of SBP maintained at such levels with risk of vascular events after a recent ischemic stroke is unclear. OBJECTIVE:To assess the association of maintaining low-normal vs high-normal SBP levels with risk of recurrent stroke. DESIGN, SETTING, AND PATIENTS:Post hoc observational analysis of a multicenter trial involving 20,330 patients (age ≥50 years) with recent non-cardioembolic ischemic stroke; patients were recruited from 695 centers in 35 countries from September 2003 through July 2006 and followed up for 2.5 years (follow-up ended on February 8, 2008). Patients were categorized based on their mean SBP level: very low-normal (<120 mm Hg), low-normal (120-<130 mm Hg), high-normal (130-<140 mm Hg), high (140-<150 mm Hg), and very high (≥150 mm Hg). MAIN OUTCOME MEASURES:The primary outcome was first recurrence of stroke of any type and the secondary outcome was a composite of stroke, myocardial infarction, or death from vascular causes. RESULTS:The recurrent stroke rates were 8.0% (95% CI, 6.8%-9.2%) for the very low-normal SBP level group, 7.2% (95% CI, 6.4%-8.0%) for the low-normal SBP group, 6.8% (95% CI, 6.1%-7.4%) for the high-normal SBP group, 8.7% (95% CI, 7.9%-9.5%) for the high SBP group, and 14.1% (95% CI, 13.0%-15.2%) for the very high SBP group. Compared with patients in the high-normal SBP group, the risk of the primary outcome was higher for patients in the very low-normal SBP group (adjusted hazard ratio [AHR], 1.29; 95% CI, 1.07-1.56), in the high SBP group (AHR, 1.23; 95% CI, 1.07-1.41), and in the very high SBP group (AHR, 2.08; 95% CI, 1.83-2.37). Compared with patients in the high-normal SBP group, the risk of secondary outcome was higher for patients in the very low-normal SBP group (AHR, 1.31; 95% CI, 1.13-1.52), in the low-normal SBP group (AHR, 1.16; 95% CI, 1.03-1.31), in the high SBP group (AHR, 1.24; 95% CI, 1.11-1.39), and in the very high SBP group (AHR, 1.94; 95% CI, 1.74-2.16). CONCLUSION:Among patients with recent non-cardioembolic ischemic stroke, SBP levels during follow-up in the very low-normal (<120 mm Hg), high (140-<150 mm Hg), or very high (≥150 mm Hg) range were associated with increased risk of recurrent stroke.
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Re: Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
posted at 30/8/2012 3:27 AM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hi all: The optimal BP levels for diabetics is still an unresolved issue and I doubt if it will be resolved in diabetics anytime in the near future. 1. Are office BP levels reliable? No they are not. White coat and masked hypertension can be found in 30 to 40% diabetics. We need much more ABPM data in diabetics. 2. BP levels are just surrogates markers (just numbers) for the diabetes complications or pathophysiology. And whenever we trust all that much in surrogates we are predisposing ourselves to errors. 3. Each day it comes up new data showing that targets (numbers) for diagnosis and treatment tend to induce overdiagnosis and polypharmacy. The best treatments tend to be individualised to each patient´s clinical scenario. Having said that, there seems to be an advantage for fewer strokes with lower BP levels, but at what price? It all depends on the risk/benefit ratio for each patient with different ages and co-morbidities. So, individualised treatments seems to be the best approach. All Best, Joey |
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Re: Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
posted at 31/8/2012 4:30 PM BST
on bmj.com
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
Well said Joey. thanks for all of the posts yoram. This is practically a review article. |
Forums » Open clinical » Diabetes » Review: Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.
