What should the optimal blood pressure goal be in patients with diabetes mellitus or chronic kidney disease?

In the absence of randomized control data, the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended that patients with diabetes mellitus or with chronic kidney disease should have their blood pressure reduced to less than 130/80 mm Hg [1]. In the absence of randomized control data, the American Diabetes Association recommended that patients with diabetes mellitus and hypertension should have their blood pressure reduced to less than 130/80 mm Hg [2]. In the absence of randomized control data, the National Kidney Foundation Kidney Disease Outcome Quality Initiative guidelines recommended that patients with chronic kidney disease and hypertension should have their blood pressure reduced to less than 130/80 mm Hg [3]. In the absence of randomized control data, the American Heart Association 2007 guidelines recommended that patients with diabetes mellitus or with chronic kidney disease and hypertension should have their blood pressure reduced to less than 130/80 mm Hg [4]. The 2009 European Society of Hypertension guidelines stated that reducing the blood pressure to less than 130/80 mm Hg in patients with diabetes mellitus or chronic kidney disease and hypertension is unsupported by prospective trial data, and that the systolic blood pressure should be reduced to less than 140 mm Hg in these patients [5]. The American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in the elderly recommended that the blood pressure should be reduced to less than 140/90 mm Hg in adults younger than 80 years with diabetes mellitus or chronic kidney disease [6]. On the basis of data from the Hypertension in the Very Elderly trial [7], these guidelines recommended that the systolic blood pressure should be reduced to 140 mm Hg to 145 mm Hg if tolerated in adults aged 80 years and older [6]. I concur with these guidelines [5, 6, 8-13]. The following studies discuss the reasons for my recommendations. The Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction (PROVE IT-TIMI) 22 trial enrolled 4,162 patients with an acute coronary syndrome (17% with diabetes mellitus and 9% with chronic kidney disease) [14]. At 24-month follow-up, the lowest cardiovascular events rates occurred with a systolic blood pressure between 130 mm Hg to 140 mm Hg and a diastolic blood pressure between 80 mm Hg to 90 mm Hg with a nadir of 136/85 mm Hg [14]. Corresponding author: Wilbert S. Aronow MD Cardiology Division New York Medical College Macy Pavilion, Room 138 Valhalla, NY 10595, USA Phone: (914) 493-5311 Fax: (914) 235-6274 E-mail: [email protected] Editorial