Table 1 Studies addressing the definition of the goal of blood pressure control in patients with diabetes and hypertension

INVEST

58

6,400

Observational subgroup analysis

Group 1. SBP<140

Group 1. 159/86

Group 1 have 50% higher risk of death, MI, or stroke (P< 0.0001). Group 3 in relation to group 2 have an increase of 8% of CVD after 5 years of study (p<0.04).

Group 2. SBP<140-130

Group 2. 149/85

Higher incidence of death in patients with SBP<115.

Group 3. SBP<130

Group 3. 144/85

ACCORD-BP

43

4,733

Randomized clinical trial (RCT)

Group 1. Intensive SBP<120

Group 1. 119.3/64.4

No differences in the primary end point (MI, stroke and CV death) or in death due to any cause. Higher incidence of stroke (p= 0.01) or non-fatal stroke (p=0.03). Increase of adverse events in group 1.

Group 2. Standard SBP < 140

Group 2. 133.5/70.5

IDN-T

59

1,590

Post hoc analysis

≤135/85

30% reach the SBP goal and 81% the DBP goal

Progressively lower achieved SBP to 120 predicted a decrease in CV mortality and CHF but not MI. A SBP <120 was associated with increased CV deaths and CHF events. DBP< 85 was associated with increase of all-cause mortality, MI mortality but decrease risk of stroke.

ABCD-NT

60,61

470

RCT

Group 1. DBP<75-79

132/78

No differences in any CV events, or progression of renal disease, nor retinopathy.

Group 2. DBP 80-89

138/86

ONTARGET

62

9,603

Post hoc analysis

Group 1. SBP 95-130

125.8 SD 12.0

Increased CV mortality with SBP < 125 in relation with SBP < 130.

Group 2. SBP 131-142

132.4 SD 11.2

Group 3. SBP 143-154

137.7 SD 11.5

Group 4. SBP 155-200

144.3 SD 12.6

ROADMAP

63

4,447

RCT

Group 1. SBP<130

80% achieved the target

SBP<120 showed a J-shaped increase of CV mortality.

Group 2. DBP<80

UKGPRD

64

126,092

Retrospective study

Group 1. <130/<80

Achieved target

J-shaped relationship in patients with SBP<130 In patients with CVD SBP <130 and DBP< 80 was not associated with improved survival. BP <110/75 increase the risk of CV mortality.

12,379 with CVD

Group 2. 130-139/80-<85

Group 1. SBP18.1%

Group 3. ≥140/≥85

DBP 35.7%

Group 2. SBP 19.9%

DBP 27.7%

Group 3. SBP 61%

DBP 36.6%

HOT

65

1,501

RCT

Group 1. DBP<90

Group 1. 144/85

DBP<80 showed a significantly reduction in CV events and CV mortality.

Group 2. DBP<85

Group2. 141/83

Group 3. DBP<80

Group 3. 140/81

UKPDS

71

4,801

Post hoc observational analysis

Group 1. <150/85

Group 1. 144/82

Group 1 had a significant 44% reduction of stroke, 32% of diabetes related death, 24% diabetes related end patients.

Group 2. <180/105

Group 2. 154/87