SHOULD MIDDLE-AGED AND OLDER HIGH-RISK HYPERTENSIVE PATIENTS WITH DIABETES BE TREATED TO TARGET BT <130/80 MMHG?

Objective: Diabetes Mellitus Type-2 (DM2) is common in hypertensive patients, increasing the risk of cardiovascular disease. Current guidelines recommend targeting systolic BP (SBP) to 130 - 139 mmHg in diabetic patients >65 years. We investigated whether the middle-aged and elderly hypertensive DM2 patients in the VALUE Trial had reduced risk of cardiovascular disease and death if SBP was lowered to <130 mmHg. Design and method: Of the 15,245 participants, there were 13,803 patients without cardiovascular events during the first six months after randomization, roll-over from previous medication and up-titration of study drugs. Of these 2,458 patients had left ventricular hypertrophy by electrocardiogram. These patients were excluded from analyses due to increased mortality when SBP is lowered to <130 mmHg (submitted). Of the remaining 11,345 patients, 3,932 had DM2. Cox analyses adjusted for age, gender, and baseline variables compared cardiac and all-cause mortality and other pre-specified endpoints for patients achieving average SBP 130 - 139 mmHg (DM2 group 1,605, non-DM2 group 3,260) and SBP <130 mmHg (DM2 group 600, non-DM2 group 1,546). Reference groups were patients achieving average SBP > = 140 mmHg. Results: Mean age in DM2 patients was 66.9 years. The DM2 group achieving average SBP <130 mmHg did not have significant changes in primary cardiac endpoint, all-cause mortality, or stroke (Table). However, DM2 had lower incidence of reduced kidney function (increase in serum creatinine of 50% compared to baseline, HR = 0.43, p = 0.008). In the DM2 group achieving average SBP 130 - 139 mmHg there were significant reductions in cardiovascular events and kidney function. Conclusions: Our findings suggest that lowering systolic BP <130 mmHg in DM2 has little effect on reducing cardiovascular events compared to systolic BP 130 - 139 mmHg. However, we did find an effect on kidney function. In conclusion, our data suggest that treating middle-aged and elderly DM2 patients <130/80 mmHg can prevent reduction of renal function which is an endpoint of high importance in DM2 patients.