The Blood Pressure Control Target in Diabetes (BPROAD) Study presented at the American Heart Association's Scientific Sessions 2024 reveals that intensive systolic blood pressure management significantly reduces cardiovascular risks for individuals with Type 2 diabetes. Conducted across 145 sites in China with nearly 13,000 participants, the research compared intensive treatment targeting systolic pressure below 120 mm Hg against standard treatment targeting below 140 mm Hg.
Over up to five years of follow-up, the intensive treatment group experienced a 21% lower relative risk of major cardiovascular events, including non-fatal strokes, non-fatal heart attacks, heart failure hospitalizations, and cardiovascular deaths. The annual event rate was 1.65% in the intensive group versus 2.09% in the standard group. These findings are particularly significant given that people with Type 2 diabetes are twice as likely to have high blood pressure than those without diabetes, and nearly three-quarters of adults with Type 2 diabetes have hypertension.
Dr. Guang Ning of Ruijin Hospital at Shanghai Jiao Tong University School of Medicine, who led the study, emphasized that these results provide strong support for more intensive systolic blood pressure targets in Type 2 diabetes patients for cardiovascular prevention. The outcomes align with previous research on patients with hypertension but without diabetes, which found a 27% reduction in cardiovascular disease incidence with intensive treatment.
While demonstrating clear benefits, the intensive approach carried increased risks of symptomatic hypotension and hyperkalemia compared to standard treatment. However, serious adverse events requiring hospitalization were generally similar between both groups. The study's implications could influence future clinical practice guidelines for blood pressure management in Type 2 diabetes patients, potentially improving cardiovascular outcomes for millions worldwide.
The research acknowledges limitations including lack of blinding for participants and physicians regarding treatment approaches, and adaptations in data collection methods due to the COVID-19 pandemic. As defined by the American Heart Association, high blood pressure includes systolic pressure of 130 mm Hg or higher and diastolic pressure of 80 mm Hg or higher. The BPROAD study provides compelling evidence supporting more aggressive blood pressure management in Type 2 diabetes patients while highlighting the need for future research to identify those who would benefit most while minimizing potential harm.
