Published on 16 February 2015

Current guidelines on how and when to lower blood pressure for people with type 2 diabetes, should be revised according to a new report, in order to avoid the risk of stroke and diabetes-related eye disease.

The Blood pressure lowering in type 2 diabetes: A systematic review and meta-analysis report, recently published in the Journal of American Medical Association, indicated that current EU guidelines could be putting people at risk, by ignoring evidence and threatening treatment.

Researchers from The George Institute for Global Health, affiliated with the Oxford Martin School at Oxford University, are challenging recent changes to US and European guidelines that have relaxed previous recommendations of lower blood pressure targets in people with type 2 diabetes.

Globally, it is estimated that around 387 million people have diabetes, putting them at high risk of heart disease, stroke, kidney disease and eye disease. In the UK, where about 3.2 million people have the condition, diabetes is a leading cause of kidney disease and blindness.

Most guidelines around the world recommended that people with type 2 diabetes have their blood pressure reduced to below 130/80 mmHg (milimeters of mercury), which is lower than the target of 140/90 mmHg generally recommended for people without diabetes. Until last year, when influential guidelines in the US and Europe controversially changed recommendations,

Professor Kazem Rahimi

Urging for guidelines around the world to reflect the new findings, author Professor Kazem Rahimi of The George Institute and The University of Oxford said the research provided fundamental evidence about how blood pressure should be treated in people with diabetes.

Dr Rahimi said: “Our review shows that people with diabetes who reached a systolic blood pressure below 130mmHg had about a 25% lower stroke risk compared with those with higher blood pressure levels. Our analyses indicate that lower blood pressure reduces risk of diabetic eye disease and early kidney disease too.”

Professor Anushka Patel, co-author of the paper and Chief Scientist of The George Institute for Global Health, said: “When considering blood pressure targets in these patients, it is critical to make an individualised assessment of the balance between the benefits of more intensive treatment and any adverse effects of increasing medication. This research indicates that many people with diabetes may have net benefits with more aggressive treatment.”

Blood pressure and diabetes expert, Professor Neil Poulter, of Imperial College London, who was not involved in the study, said: “I expect this study to influence guidelines for the treatment of people with diabetes, and for this to translate to appreciable effects on the health of people with diabetes.

“I have been increasingly concerned about the trend to advocate higher blood pressure targets as reflected by recent changes to guidelines in Europe and the US; this study provides the evidence needed to reconsider this.”

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