Patrice DARMON, Marseille
High blood pressure (hypertension) is extremely common in people living with type 2 diabetes (T2D) and strongly contributes to the increased cardiovascular risk in these patients. Although it has long been demonstrated that reducing blood pressure (BP) improves cardiovascular prognosis, the optimal BP targets to achieve in patients with T2D remain debated. We remember in particular the results of the ACCORD study failing to demonstrate the superiority of a systolic BP (SBP) objective of 5.5 mmol/l (2.8% vs 2.0%). Most international recommendations today agree to set a SBP target between 120 and 130 mmHg, under the guise of good tolerance, in patients living with T2D. Fifteen years after the negative results of ACCORD (probably linked to a lack of power), the conclusions of the BPROAD study could lead to now proposing a SBP target of less than 120 mmHg with increased vigilance on the side effects of treatments , subject to being able to be extrapolated to non-Chinese populations. However, it is necessary to highlight the low use of SGLT2 inhibitors and GLP-1 receptor agonists in BPROAD (10.4% and 4.4%, respectively): the increasingly widespread use in patients living with T2D of these molecules with cardioprotective properties could also modify the conclusions of this type of study and change the situation.
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