| The Journal of Clinical Hypertension, 8;1:29-34 (January, 2006) |
|
| Attempted Forced Titration of Blood Pressure to <130/85 mm Hg
in Type 2 Diabetic Hypertensive Patients in Clinical Practice: The
Diastolic Cost |
|
| Esther Osher, MD ; Yona Greenman, MD ; Karen Tordjman, MD ; Eldad
Kisch, MD, PhD ; Galina Shenkerman, MD ; Michael Koffler, MD ; Itzhak
Shapira, MD ; Naftali Stern, MD |
|
| The Institute of Endocrinology, Metabolism and Hypertension, Tel
Aviv –Sourasky Medical Center and Sackler Faculty of Medicine, Tel
Aviv University, Israel |
|
The authors assessed the practicality and results of forced titrating
of blood pressure to <130/85 mm Hg based on guidelines of the sixth
Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure in the setting of a clinical practice
in 257 diabetic, hypertensive patients. Goal diastolic pressure was
achieved in 90% of the patients, but goal systolic pressure
was achieved in only 33%. In 57% of the patients,
the attained diastolic pressure was ≤70 mm Hg, and in 20%
of the cohort diastolic pressure was reduced to <70 mm Hg (mean,
60±1 mm Hg). Patients with final diastolic pressure <70 mm Hg were
older, had a higher prevalence of coronary artery disease, and higher
initial systolic and pulse pressures compared with patients with final
diastolic pressure of 71–85 mm Hg. Thus, attempted lowering of blood
pressure to <130/85 mm Hg is associated with excessive lowering
of diastolic pressure in a significant number of patients. Whether
the benefits of tight systolic control outweigh the risks of excessive
diastolic reduction requires further prospective assessment.
|
