In May I commented on a study in the New England Journal of Medicine that failed to show a benefit in lowering systolic blood pressure below 130 mm Hg. Well, now there’s another such study. This one is in the Journal of the American Medical Association. “Patients were categorized into 3 groups by their average systolic BP while taking study medication: tight control, less than 130mmHg; usual control, 130 mm Hg to less than 140 mm Hg; or uncontrolled, 140 mm Hg or higher.” The paper’s last paragraph is below:
In conclusion, our data from this post hoc analysis in the cohort of patients with diabetes enrolled in INVEST [which was a prospective, randomized trial comparing clinical outcomes of 22 576 patients with hypertension and CAD] indicate that tight control of systolic BP was not associated with improved cardiovascular outcomes compared with usual control. At this time, there is no compelling evidence to indicate that lowering systolic BP below 130mmHg is beneficial for patients with diabetes; thus, emphasis should be placed on maintaining systolic BP between 130 and 139 mm Hg while focusing on weight loss, healthful eating, and other manifestations of cardiovascular morbidity to further reduce long-term cardiovascular risk.
It had seemed to almost everyone who thought about vascular disease in patients with diabetes that aiming for a blood pressure of about 120 was a good idea. But the data seem to contradict our thinking. It’s discouraging to concede how often really good ideas turn out to be wrong. Humility belongs not just to medical science, it should be generously applied to almost every surface.