toolow /BP not good for diabetic/cardiac patient

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This article originally posted 16 July, 2010 and appeared in

Issue 530

Recommended Blood Pressure Level Differs for Heart Patients with Diabetes

The best blood pressure range for patients with diabetes and heart disease

appears to be slightly higher than what is recommended for healthy adults,

according

to a study. Blood pressure greater than 140 is still associated with a

nearly 50 percent increase in cardiovascular risk in these patients....

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In fact, the blood pressure range considered normal -- less than 120

systolic and less than 80 diastolic -- may actually be risky for those with

a combined

diagnosis of diabetes and coronary artery disease, report University of

Florida researchers from the International Verapamil SR-Trandolapril study,

known

as INVEST.

According to Rhonda -DeHoff, Pharm.D., an associate professor of

pharmacy and medicine at UF, optimum systolic blood pressure levels should

be between

130 and 140 for patients coping with the diabetes-heart disease combination.

Efforts to reduce systolic blood pressure to below 130 did not offer any

additional benefit to patients with diabetes and coronary artery disease,

compared

with reduction of systolic blood pressure to between 130 and less than 140.

" Sustained blood pressure lower than 120 is considered optimal for healthy

people, " -DeHoff said. " But, our data show that for these patients

with

diabetes, the range may actually cause an increased risk for heart attack,

stroke, and death. "

As many as two out of three adults with diabetes have high blood pressure.

Blood pressure greater than 140 is still associated with a nearly 50 percent

increase in cardiovascular risk in these patients.

" While lowering blood pressure to less than 140 is very important, based on

our data and data recently published by others, it is now clear that in

patients

with diabetes, it is not necessary, and may be harmful to lower blood

pressure too much, " -DeHoff said.

In addition, the study for the first time reveals that this group of

patients had an increased risk for death when their blood pressure was

controlled

to lower than 115 systolic -- the range recommended as normal by the

American Heart Association.

The findings in the Journal of American Medical Association formalize a

report -DeHoff made at the American College of Cardiology's 59th

annual scientific

session earlier this spring.

Heart disease or stroke is the top cause of death for people with diabetes,

affecting more than 60 percent of patients, according to the AHA. High blood

pressure, common in diabetes, doubles the risk of cardiovascular disease.

The INVEST study is the first to evaluate the effects of blood

pressure-lowering in diabetic patients diagnosed with coronary artery

disease. Researchers

analyzed data collected from 6,400 patients from fall 1997 to spring 2003.

The patients, who were 50 or older, were recruited from more than 850 sites

in 14 countries.

The researchers further consulted the national death index for U.S.-enrolled

patients for an additional five years to compare death rates of patients

based

on their blood pressure category ranging from tightly controlled to

non-controlled hypertension.

Journal of the American Medical Association, July 10, 2010