Several trials have shown that uncontrolled hypertension is a major risk factor for the development of cardiac, vascular, renal, and cerebrovascular disease, morbidity, and mortality. However, even modest reductions in blood pressure (BP) decrease morbidity and mortality. Further studies are needed to confirm optimal BP targets in diabetes.
In one randomized clinical trial (ACCORD) a more stringent blood pressure goal for patients with type 2 diabetes did not significantly reduce the primary cardiovascular outcome or most secondary outcomes compared with standard blood pressure goals. In this study, the number of total and nonfatal strokes was lower in the intensive therapy group, although the clinical benefit was limited (number needed to treat = 89 for 5 years to prevent one stroke).
In patients with diabetes, the decrease in asleep blood pressure - a novel therapeutic target requiring evaluation by ambulatory monitoring - has been shown to be the most significant independent predictor of event-free survival in some studies.
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