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Diastolic Blood Pressure Does Not Influence Cardiovascular Outcomes in Type 2 Diabetes; or Does It?

Hypertension and diabetes are prominent cardiovascular (CV) risk factors and major issues of public health (1,2). The common coexistence of hypertension and type 2 diabetes is long-established and represents a “deadly” combination: diabetes increases CV risk threefold at any level of systolic blood pressure (SBP), while the presence of hypertension in patients with diabetes increases CV risk by fourfold (3,4).

The optimal level of blood pressure (BP) in patients with diabetes has been a matter of debate for many years (5–7). Following older observational evidence and interventional data from the UK Prospective Diabetes Study (UKPDS) 38 and Hypertension Optimal Treatment (HOT) study, which showed CV benefits with diastolic blood pressure (DBP) of 15% 10-year CV risk) with type 2 diabetes to a target SBP of <120 mmHg or <140 mmHg. After 4.7 years of follow-up, the two groups had no differences in the primary outcome (nonfatal myocardial infarction, nonfatal stroke, death from CV causes) (hazard ratio [HR] 0.88, 95% CI 0.73–1.06; P = 0.20), CV mortality, and all-cause mortality; those in the intensive group had fewer stroke events (HR 0.59, 95% CI 0.39–0.89) but a higher incidence of serious adverse events (3.3% vs. 1.3%, P < 0.001), including hypotension, syncope, arrhythmias, hyperkalemia, angioedema, and renal failure.

The ACCORD BP findings were considered by many as conclusive evidence against the <130 mmHg …