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Blood pressure treatment levels and choice of antihypertensive agent in people with diabetes mellitus : an overview of systematic reviews

Brunström, Mattias; Eliasson, Mats; Nilsson, Peter M. LU and Carlberg, Bo (2017) In Journal of Hypertension 35(3). p.453-462
Abstract

OBJECTIVE:: Multiple systematic reviews address the effect of antihypertensive treatment in people with diabetes. Here, we summarize current systematic reviews concerning antihypertensive treatment effect at different blood pressure (BP) levels, and relative treatment effect of different antihypertensive agents. METHODS:: We searched MEDLINE, BIOSIS, DARE and CDSR during years 2005–2016. Eligibility criteria, number of trials and participants, outcomes analysed, statistical methods used for data synthesis, and principal results were extracted for each review. Review quality was assessed using the assessment of multiple systematic reviews tool. RESULTS:: We found four reviews concerning BP treatment level. These consistently showed that... (More)

OBJECTIVE:: Multiple systematic reviews address the effect of antihypertensive treatment in people with diabetes. Here, we summarize current systematic reviews concerning antihypertensive treatment effect at different blood pressure (BP) levels, and relative treatment effect of different antihypertensive agents. METHODS:: We searched MEDLINE, BIOSIS, DARE and CDSR during years 2005–2016. Eligibility criteria, number of trials and participants, outcomes analysed, statistical methods used for data synthesis, and principal results were extracted for each review. Review quality was assessed using the assessment of multiple systematic reviews tool. RESULTS:: We found four reviews concerning BP treatment level. These consistently showed that the effect of antihypertensive treatment on mortality, cardiovascular disease and coronary heart disease was attenuated at lower BP levels. If SBP was more than 140?mmHg, treatment reduced all-cause and cardiovascular mortality, cardiovascular disease, stroke, myocardial infarction and heart failure. If SBP was less than 140?mmHg, treatment increased the risk of cardiovascular death. We found eight reviews concerning choice of agent. We found no difference between angiotensin-converting enzyme inhibitors, angotensin receptor blockers, beta-blockers, calcium channel blockers and diuretics in preventing all-cause or cardiovascular mortality, combined cardiovascular disease, coronary heart disease and end-stage renal disease. Minor differences exist for stroke and heart failure. Data were limited on people with type 1 diabetes and very elderly patients with type 2 diabetes. None of the reviews concerning choice of agent included all relevant trials. CONCLUSION:: The available evidence supports treatment in people with type 2 diabetes and SBP more than 140?mmHg, using any of the major antihypertensive drug classes.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Hypertension
volume
35
issue
3
pages
453 - 462
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:84996917474
  • wos:000393822200004
ISSN
0263-6352
DOI
10.1097/HJH.0000000000001183
language
English
LU publication?
yes
id
57f51c43-756d-4d0f-bf11-70ccf9c7ed15
date added to LUP
2016-12-12 09:42:36
date last changed
2018-01-07 11:40:28
@article{57f51c43-756d-4d0f-bf11-70ccf9c7ed15,
  abstract     = {<p>OBJECTIVE:: Multiple systematic reviews address the effect of antihypertensive treatment in people with diabetes. Here, we summarize current systematic reviews concerning antihypertensive treatment effect at different blood pressure (BP) levels, and relative treatment effect of different antihypertensive agents. METHODS:: We searched MEDLINE, BIOSIS, DARE and CDSR during years 2005–2016. Eligibility criteria, number of trials and participants, outcomes analysed, statistical methods used for data synthesis, and principal results were extracted for each review. Review quality was assessed using the assessment of multiple systematic reviews tool. RESULTS:: We found four reviews concerning BP treatment level. These consistently showed that the effect of antihypertensive treatment on mortality, cardiovascular disease and coronary heart disease was attenuated at lower BP levels. If SBP was more than 140?mmHg, treatment reduced all-cause and cardiovascular mortality, cardiovascular disease, stroke, myocardial infarction and heart failure. If SBP was less than 140?mmHg, treatment increased the risk of cardiovascular death. We found eight reviews concerning choice of agent. We found no difference between angiotensin-converting enzyme inhibitors, angotensin receptor blockers, beta-blockers, calcium channel blockers and diuretics in preventing all-cause or cardiovascular mortality, combined cardiovascular disease, coronary heart disease and end-stage renal disease. Minor differences exist for stroke and heart failure. Data were limited on people with type 1 diabetes and very elderly patients with type 2 diabetes. None of the reviews concerning choice of agent included all relevant trials. CONCLUSION:: The available evidence supports treatment in people with type 2 diabetes and SBP more than 140?mmHg, using any of the major antihypertensive drug classes.</p>},
  author       = {Brunström, Mattias and Eliasson, Mats and Nilsson, Peter M. and Carlberg, Bo},
  issn         = {0263-6352},
  language     = {eng},
  number       = {3},
  pages        = {453--462},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Hypertension},
  title        = {Blood pressure treatment levels and choice of antihypertensive agent in people with diabetes mellitus : an overview of systematic reviews},
  url          = {http://dx.doi.org/10.1097/HJH.0000000000001183},
  volume       = {35},
  year         = {2017},
}