People with type two diabetes should strive for blood pressure of 120 mm Hg to keep the risk of a large cardiovascular event low, say the Jiao Tong university scientists. A massive clinical study carried out in China has shown that the current blood pressure recommendations for people with type -2 -diabetes may have to be revised.
In the study, which was published in the New England Journal of Medicine last month, a consortium of doctors from the entire People’s Republic of China worked with Shanghai experts to examine whether the current blood pressure guidelines for type -2 diabetes are missing the brand. One of the most common complications of type two diabetes is the effect on the cardiovascular system. People with type -2 diabetes have an increased risk of stroke and heart attack.
How low should we go?
For many years, the standard treatment for type two diabetics has been to encourage people to keep their blood pressure below the limit for high blood pressure. Hypertension is a disease in which a person’s blood pressure is high enough to escalate the risk of a cardiovascular event. The lower limit for high blood pressure is a systolic blood pressure of 140 mm ed. The systolic blood pressure is a measure of the power that the blood exerts on its artery walls when its heart beats.
In theory, the blood pressure should be sufficient to reduce your chances of a stroke or a heart attack, but does this also apply to type two diabetics? Scholar of the Shanghai Jiao Tong University say: “No”. According to a huge randomized controlled study with over 12,000 participants, the researchers have concluded that type two diabetics should try blood pressure of 120 mm HG or less in Asia to minimize their risk.
The current practice in most regions is that people with type -2 diabetes should strive for systolic blood pressure of 140 mm Hg. The idea is that at more than 140 mm Hg, the stress for your arteries can lead to hardening of the blood vessel walls or mechanical damage that can contribute to atherosclerosis and other diseases.
The risk weight
Doctors have known for a long time that when people take measures to reduce their blood pressure, their chance of having a stroke or a heart attack. Whether this is due to the fact that lower blood pressure for your blood vessels is gentler or that the same problem that makes blood pressure high makes cardiovascular events more likely, the result is the same.
Lower blood pressure means a low risk of heart attack, stroke, heart failure and other cardiovascular events.
However, the challenge comes when you have more than a risk factor for cardiovascular problems. Imagine every risk factor for heart attack or stroke is a pebble that you carry around with you. The more stones in your pocket, the more difficult you have to work through your heart cycle system for every day.
You may illustrate a pebble that illustrates your stress levels. A boulder could be their smoking habits and a small rock could be the fact that they had in front of the eclampsia during their pregnancy. Another small stone could be that they have a genetic predisposition to high blood pressure. A small pebble represents a high systolic blood pressure (which is more than 120 mm Hg) and a large rock corresponds to high blood pressure (blood pressure above 140 mm Hg). The metabolic changes supplied with type -2 diabetes give the stack another boulder.
Throwing rocks lowers their chances of having a heart attack or a stroke. Some stones are more difficult to lose than others. If you cannot get rid of the diabetes boulder, it can be a way to reduce your risk to lower some of your other stones that lead to a similar size. Should Type -Wwo -Diabetics drop your high blood pressure stone together with your high blood pressure?
Is it time to rethink the turning point for diabetics?
Are blood pressure recommendations for type -2 diabetics too high?
The Shanghai researchers set the hypothesis that the drop in target blood pressure to 120 mm Hg should reduce the number of cardiovascular events such as stroke or heart attack in type -2 diabetics. They carried out a direct experiment in which the results of Type -2 diabetics were compared and continued with normal hypertension therapy with type -2 diabetics, which aimed at blood pressure of 120 mm hg with a more intensive treatment regime. Would the lowering of the target blood pressure reduce the number of heart attacks and strokes after five years?
In a controlled, randomized clinical study, the doctors recruited over 12,000 participants in 145 hospitals and clinics. The researchers gathered a cohort of type -2 diabetics aged over 50 years. They each had a systolic blood pressure between 130 mm Hg and 180 mm Hg, if they had taken blood pressure medicine, and 140 mm HG if they did not use medication. After all, the participants all had a high risk of cardiovascular problems. This included people with chronic kidney diseases and a prehistory of clinical or subclinical cardiovascular diseases for at least three months or three years before the study.
The doctors accidentally assigned one of two groups to each participant. These were people who would follow the standard treatment for high blood pressure. You would use blood pressure -lowering medication to achieve blood pressure below 140 mm Hg. The other group would use antihypertensives to get their blood pressure below 120 mm Hg. The groups were evenly in relation to age, gender, education, medical history and basic blood work.
Every three months, the clinics used an electronic data system to pass on statistics to the researchers. They collected information about blood pressure, kidney function, cardiovascular health and reports about a cardiovascular event. Cardiovascular events were not fatal stroke, non -fatal heart attack, treatment or hospital stay in heart failure or death by cardiovascular causes.
The team then followed the 12,821 participants over the next five years to see which treatment protocol would win.
The patients knew which treatment group they were in, but the doctors who collected and analyzing their cardiovascular data throughout the study did not know who received which care.
Under pressure
At the end of the study, the results were clear. The average starting blood pressure for both groups was 140 mm HG plus or minus 10 mm hg. After only one year of intensive blood pressure control, the 120 mm HG target group had an average systolic blood pressure of 118 mm hg. The standard treatment group reached average 133 mm Hg. The two groups have retained this average blood pressure for the next four years.
The intervention worked in terms of blood pressure, but would it lead to a decline in cardiovascular problems? After five years, the researchers reported that the participants who sought blood pressure below 120 mm HG had 21% less likely to achieve a primary cardiovascular result than people who adhered to the standard treatment. In the intensive blood pressure control group 393 of 6414, participants were treated for a stroke, heart attack, due to heart failure or died due to cardiovascular causes. In the standard treatment group, 492 of 6407 participants experienced these results. The difference between the two groups was both statistically significant and clinically significant.
The groups were also probably undesirable events from the treatment, around 36%. This showed that intensive blood pressure control was not more harmful than the standard treatment. The different approaches to blood pressure had no influence on the rate of progression of chronic kidney diseases.
A stroke of luck
Overall, the researchers came to the conclusion that the risk of poor cardiovascular result with intensive blood pressure control by 21% after dealing with the supply of the type of two type.
They made some observations about the limits of their study. First, people are eliminated throughout the process. While they started at 12,821, they only collected data for around 3000 participants by the end of the fifth year. The study started shortly before pandemic, and for at least a year some patients reported data in the clinics by phone. The researchers only examined systolic blood pressure. They did not test how diastolic blood pressure reacted to treatment or how it is related to cardiovascular events. The study was only partially blinded – both the participants and their treating doctors knew what treatment they got. Placebo effects or distortions in the reporting results could play a role.
After all, people of East Asian descent have a higher risk for type -2 -diabetes, high blood pressure and cardiovascular diseases than other populations. For example, people with a Chinese heritage develop a metabolic syndrome rather than white European population groups with a lower BMI. This means that the intensive blood pressure control approach for diabetics type two may have to be tested in other ethnic groups before taking over as the standard of care.
Put off the pressure
According to the authors, these findings are very encouraging when it comes to preventing a stroke. Within the Chinese population, high blood pressure is the greatest risk factor for non -fatal stroke and fatal stroke. Stroke is the most common cardiovascular condition for this demography. Long -term disabilities that have a significant impact on the quality of life and the ability of people to take care of themselves can significantly influence non -fatal strokes.
Let’s return to our bag full of pebbles. The good news is that for people of Chinese descent, larger rocks with the genetic high blood pressure, type -2 diabetes and BMI bring with them that are high blood pressure and high blood pressure stones in antihypertensive. The drop in the blood pressure target to less than 120 mm Hg for type two diabetics has a significant influence on the number of extended life and the reduction of the weakening long -term complications that result from a stroke.
Bi y, li m, liu y, et al. Intensive blood pressure control in patients with type 2 diabetes. New England Journal of Medicine. 2025; 392 (12): 1155-1167. DOI: 10.1056/nejmoa2412006