Effects of intensive blood pressure reduction on myocardial infarction and stroke in diabetes: A meta-analysis in 73 913 patients

Gianpaolo Reboldi, Giorgio Gentile, Fabio Angeli, Giuseppe Ambrosio, Giuseppe Mancia, Paolo Verdecchia

Research output: Contribution to journalArticle

Abstract

Objective: Guidelines generally recommend intensive lowering of blood pressure (BP) in patients with type 2 diabetes. There is uncertainty about the impact of this strategy on case-specific events. Thus, we generated estimates of the effects of BP reduction on the risk of myocardial infarction (MI) and stroke in diabetic patients. Methods: We selected studies which compared different BP-lowering agents and different BP intervention strategies in patients with diabetes. Outcome measures were MI and stroke. We abstracted information about study design, intervention, population, outcomes, and methodological quality for a total of 73 913 patients with diabetes (295 652 patient-years of exposure) randomized in 31 intervention trials. Results: Overall, experimental treatment reduced the risk of stroke by 9% (P = 0.0059), and that of MI by 11% (P = 0.0015). Allocation to more-tight, compared with less-tight, BP control reduced the risk of stroke by 31% [relative risk (RR) 0.61, 95% confidence interval (CI) 0.48-0.79], whereas the reduction in the risk of MI approached, but did not achieve, significance [odds ratio (OR) 0.87, 95% CI 0.74-1.02]. In a meta-regression analysis, the risk of stroke decreased by 13% (95% CI 5-20, P = 0.002) for each 5-mmHg reduction in SBP, and by 11.5% (95% CI 5-17, P <0.001) for each 2-mmHg reduction in DBP. In contrast, the risk of MI did not show any association with the extent of BP reduction (SBP: P = 0.793; DBP: P = 0.832). Conclusion: In patients with diabetes, protection from stroke increases with the magnitude of BP reduction. We were unable to detect such a relation for MI.

Original languageEnglish
Pages (from-to)1253-1269
Number of pages17
JournalJournal of Hypertension
Volume29
Issue number7
DOIs
Publication statusPublished - Jul 2011

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Keywords

  • cardiovascular risk
  • diabetes
  • hypertension
  • meta-analysis
  • myocardial infarction
  • stroke

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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