Evolution of the Target Blood Pressure in Diabetes. Analysis of International Experience

Introduction. In economically developed countries, diabetes is ranked fourth in the ranking of the most common causes of death. It is known that 75.0 % of complications of diabetes mellitus (DH) due to cardiovascular or kidney damage are due to arterial hypertension (AH), which is twice as likely to occur in patients with DM than in other groups of patients. For a combination of DMwith hypertension, the risk of coronary heart disease increases by 2-4 times, stroke – twice or triple. Thus, hypertension in patients with diabetes should be as early as possible to diagnose and start treatment as soon as possible. Aim. To analyze the results of international studies and current recommendations regarding the target level of systolic and diastolic blood pressure (BP) in patients with DM. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method was used to analyze the data of the international studies (UKPDS, HOT, ADVANCE, ACCORD and ONTARGET) and modern recommendations of ESC, AHA, ACC and CDC, as well as the recommendations of the Ukrainian association of cardiologists, for the target levels of systolic and diastolic blood pressure. Results. In the 60's and 90's of the last century deepening the knowledge about the harmful effects of high BP on the organs led to a change in the guidelines of the treatment of hypertension. There was a change in the targets of BP as a goal of treatment. If in the 60's the desired result of treatment was considered to reduce BP to 160/90 mm Hg, in the 90's it was to keep the BP in the range of 140/90 mm Hg. According to these recommendations, lowering the BP levels is important in preventing the macular and microvascular complications of DM. In most of the recommendations suggested in the following years, there are no specific indications for the target levels of blood pressure and these comments have not been made in the key algorithm of the treatment for adults with AH. The guidance and unified clinical protocol “Arterial Hypertension”, developed by the working group of the Ministry of Health of Ukraine on the basis of the recommendations of the Association of Cardiologists of Ukraine and approved by the Order of the Ministry of Health of Ukraine N 384 dated 24 May 2012, include such requirements for the treatment of hypertension in patients with DM type 2: patients with diabetes should be treated to achieve the systolic BP ≤130.0 mm Hg (class C) and diastolic blood pressure <80.0 mm Hg (class A). The indicated target BP levels are the same as the threshold level of BP at the beginning of the treatment. Combined treatment using two first line drugs may be considered as an initial treatment in cases of hypertension, if systolic blood pressure is 20.0 mm Hg or if diastolic blood pressure is 10.0 mm Hg higher than the target (class B). Conclusions. It can be concluded that, despite the numerous studies and recommendations, today there is no unanimous viewpoint regarding the level of systolic and diastolic blood pressure in patients with hypertension and diabetes. The concept of “lower is better” hypothesis and J-shaped blood pressure lowering dependence remain competitive and require further study.