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Bloeddruk bij diabetes onder de 140 mm Hg behandelen geassocieerd met toename sterfte aan HVZ
Datum: 03.03.2016
Bloeddruk behandelen boven de 140 mm Hg is goed, maar doorgaan met behandelen bij een waarde onder de 140 niet volgens dit onderzoek. Het levert geen voordelen op terwijl het risico van cardiovasculaire sterfte toeneemt.


Bron: BMJ. 2016 Feb 24;352:i717. doi: 10.1136/bmj.i717.

Effect of antihypertensive treatment at different blood pressure levels in
patients with diabetes mellitus: systematic review and meta-analyses.


Brunström M(1), Carlberg B(2).


Abstract:

OBJECTIVE: To assess the effect of antihypertensive treatment on mortality and
cardiovascular morbidity in people with diabetes mellitus, at different blood
pressure levels.
DESIGN: Systematic review and meta-analyses of randomised controlled trials.
DATA SOURCES: CENTRAL, Medline, Embase, and BIOSIS were searched using highly
sensitive search strategies. When data required according to the protocol were
missing but trials were potentially eligible, we contacted researchers,
pharmaceutical companies, and authorities.
ELIGIBILITY CRITERIA: Randomised controlled trials including 100 or more people
with diabetes mellitus, treated for 12 months or more, comparing any
antihypertensive agent against placebo, two agents against one, or different
blood pressure targets.
RESULTS: 49 trials, including 73 738 participants, were included in the
meta-analyses. Most of the participants had type 2 diabetes. If baseline systolic
blood pressure was greater than 150 mm Hg, antihypertensive treatment reduced the
risk of all cause mortality (relative risk 0.89, 95% confidence interval 0.80 to
0.99), cardiovascular mortality (0.75, 0.57 to 0.99), myocardial infarction
(0.74, 0.63 to 0.87), stroke (0.77, 0.65 to 0.91), and end stage renal disease
(0.82, 0.71 to 0.94). If baseline systolic blood pressure was 140-150 mm Hg,
additional treatment reduced the risk of all cause mortality (0.87, 0.78 to
0.98), myocardial infarction (0.84, 0.76 to 0.93), and heart failure (0.80, 0.66
to 0.97). If baseline systolic blood pressure was less than 140 mm Hg, however,
further treatment increased the risk of cardiovascular mortality (1.15, 1.00 to
1.32), with a tendency towards an increased risk of all cause mortality (1.05,
0.95 to 1.16). Metaregression analyses showed a worse treatment effect with lower
baseline systolic blood pressures for cardiovascular mortality (1.15, 1.03 to
1.29 for each 10 mm Hg lower systolic blood pressure) and myocardial infarction
(1.12, 1.03 to 1.22 for each 10 mm Hg lower systolic blood pressure). Patterns
were similar for attained systolic blood pressure.
CONCLUSIONS: Antihypertensive treatment reduces the risk of mortality and
cardiovascular morbidity in people with diabetes mellitus and a systolic blood
pressure more than 140 mm Hg. If systolic blood pressure is less than 140 mm Hg,
however, further treatment is associated with an increased risk of cardiovascular
death, with no observed benefit.

PMID: 26920333