New research says US/EU relaxation of diabetes blood pressure lowering guidelines ignore evidence, endanger treatment
New research says US/EU relaxation of diabetes blood pressure lowering guidelines ignore evidence, endanger treatment.
Australia needs to resist controversial trend to change guidelines for 1 million people with diabetes and continue focus on aggressive, targeted blood pressure lowering treatment.
Starting blood pressure lowering earlier in diabetes patients and treating it more aggressively provides important health benefits such as reduced risk of stroke, according to research published today in the Journal of American Medical Association.
The findings of the study, the most comprehensive systemic review of research in this area, challenge recent changes to US and European guidelines that have relaxed previous recommendations of lower blood pressure targets in people with diabetes, a concerning trend according to the group of researchers from The George Institute for Global Health. Researchers urged that Australia not follow the US and European lead and maintain the current guidelines.
Globally, it is estimated that about 400 million people have diabetes putting them at high risk of heart disease, stroke, kidney disease and eye disease. Diabetes is the leading cause of kidney failure and blindness for Australia’s 1 million people with this condition. People with diabetes have a two to three-fold increased risk of cardiovascular disease, including stroke.
Urging for guidelines around the world to reflect the new findings, senior author Professor Anushka Patel of The George Institute and The University of Sydney said this research provides fundamental evidence about how blood pressure should be treated in people with diabetes.
“This is a big deal: recent changes to influential guidelines in the US and Europe go in the wrong direction and can lead to many more people being inadequately treated. Although we did not see effects on risks of death and heart disease, our analyses indicate that many patients with diabetes will benefit from earlier and more intensive blood pressure lowering, by reducing their risks of stroke, diabetic eye disease and early kidney disease,” says Professor Patel. ““We urgently call for these recent changes to guidelines to be modified and for all guidelines around the world to consistently reflect the evidence so patients with diabetes are receiving the best possible treatment.”
“For example, 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”, added Patel.
“Until last year, when influential guidelines in the US and Europe controversially changed recommendations, most guidelines around the world recommended that people with diabetes have their blood pressure reduced to below 130/80 mmHg, which is lower than the target of 140/90 mmHg generally recommended for people without diabetes. Our research findings indicate that many people with diabetes will benefit from the lower targets.”
Co-author of the paper, Professor Bruce Neal of The George Institute Australia, explains that these findings support an individualised approach to treating diabetes and high blood pressure.
“When considering blood pressure targets in these patients, it’s important to make an individualised assessment of the balance between the benefits of more intensive treatment and any adverse effects of increasing medication,” says Professor Neal. “This research indicates that many people with diabetes will have net benefits with more aggressive treatment.”
Stephen Colagiuri, Professor of Metabolic Health and Director of The Boden Institute at the University of Sydney, said the increasing prevalence of diabetes globally and in Australia is an “unfolding nightmare” and that treatment recommendations need to reflect the best available evidence.
Professor Colagiuri, a diabetes expert not involved in the study, said he was very pleased the review had been carried out. “This research supports s current Australian guidelines and I expect this to translate to appreciable effects on the health of people with diabetes.”
“I have been increasingly concerned about the trend for guidelines elsewhere to advocate higher blood pressure targets in people with diabetes and this study provides the evidence needed to reconsider this.”
Maya Kay, Communications Manager Australia
The George Institute for Global Health
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