Scientists have identified new approaches to blood pressure control after stroke and diabetes

Lowering blood pressure helps to reduce the risk of cardiovascular complications, but equally intensive monitoring of indicators does not always give the same result. Two new studies presented at the scientific session of the American Heart Association showed that after a stroke, a lower blood pressure target can reduce the likelihood of recurrent complications, whereas in people with type 2 diabetes, a similar statistically significant effect could not be found. Why hypertension control requires an individual approach is described in the Izvestia article.

Why have scientists revised their approaches to pressure control?

Two studies published on November 7 in The New England Journal of Medicine (NEJM) focused on patients with high blood pressure and a high risk of cardiovascular complications. In both cases, the scientists compared two goals: maintaining systolic blood pressure below 120 mmHg and a more standard guideline — below 140 mmHg. Systolic pressure shows the force with which blood presses against the walls of the arteries during heart contraction.

The first study included 4,368 people who had suffered an ischemic stroke or a transient ischemic attack. The second study involved 9,476 people with type 2 diabetes and an increased risk of cardiovascular disease. The follow-up in both groups lasted about four years. The researchers evaluated how the selected targets relate to the incidence of heart attacks, strokes, cardiovascular mortality, and hospitalizations due to heart complications.

Lower blood pressure after stroke reduced the risk of complications

In a study of people who had suffered a stroke or a transient ischemic attack, more intensive pressure control was associated with a lower incidence of major cardiovascular events. During the follow-up period, such complications occurred in 10.9% of participants for whom the target was blood pressure below 120 mmHg, and in 13.5% of those for whom the target was less than 140 mmHg. Thus, the relative risk decreased by about 21%. Repeated strokes were also less common: 4.7% versus 6.4%.

At the same time, scientists noted that lower rates require careful medical monitoring. In particular, in the group of intensive pressure reduction, some renal dysfunction was more common. Although the overall incidence of serious adverse events was comparable, this result indicates the need to take into account the kidney condition and other health characteristics when choosing targets.

Why was the result different in diabetes?

The second study involved people with type 2 diabetes and an increased risk of cardiovascular disease. The researchers tested whether lowering systolic blood pressure below 120 mmHg would further reduce the likelihood of heart attack, stroke, cardiovascular death, and hospitalization due to heart complications. However, there was no statistically significant advantage over a more standard target below 140 mmHg.

During the four years of follow-up, major cardiovascular events occurred in 6% of the participants in the group with a lower target mark and in 6.7% of the participants in the second group. The difference corresponded to an approximately 10% reduction in relative risk, but did not reach statistical significance. In addition, deterioration of kidney function was more often recorded in the intensive control group: 5.7% of participants had such events compared to 3.7% in the comparison group.

The authors do not consider this to be evidence that more intensive pressure control is useless for people with diabetes. The possible positive effect could be small, and the study did not allow us to confirm it statistically. The head of the work, Carla Santo, stressed that the data obtained complement the available information about the targets, but do not provide a universal answer for all patients.

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Why a single pressure target may not be enough

The results of two studies show that the effect of more intensive pressure control may depend on a person's health status and medical history. After a stroke, the decrease in the target was accompanied by a marked decrease in the incidence of cardiovascular complications. In type 2 diabetes, a similar strategy has not demonstrated a statistically significant advantage, and kidney function indicators require special attention.

The experts also drew attention to the practical side of pressure control. After a stroke, different specialists can monitor the patient, and it can be difficult to coordinate long-term tactics. In addition, the research results should not be automatically transferred to all population groups: both studies were conducted in Brazil, and the specifics of medical care and human health in other countries may differ. Therefore, the new data clarify approaches to hypertension control, but do not replace an individual assessment of the patient's condition.