Blood pressure targets should change for type 1 diabetes, say US researchers

Jack Woodfield
Wed, 26 Jun 2019
Blood pressure targets should change for type 1 diabetes, say US researchers
Blood pressure targets should be changed in a bid to prevent a type of heart disease in people with type 1 diabetes, US researchers have said.

A US study team followed more than 600 people for 25 years to see if they could find a pattern linking current blood pressure targets and coronary artery disease.

Participants were recruited via the Children's Hospital of Pittsburgh after they had been diagnosed with type 1 diabetes at the age of 17 or younger. The average time since diagnosis was 19 years.

The team, from the University of Pittsburgh in Pennsylvania, looked at different blood pressure targets, ranging from 110-140 mmHg systolic and from 60-90 mmHg diastolic.

Uniquely, the trial looked at time-weighted blood pressure measurements which means the long-term effect of blood pressure was taken into account.

The research team discovered that 120/80 mmHg was the optimal cut-off point, and those who had blood pressure equal or lower to this figure had a twofold decreased risk of developing coronary artery disease.

NICE's blood pressure guidelines for adults with type 1 diabetes in the UK state that "intervention levels for recommending blood pressure management should be 135/85 mmHg unless the adult with type 1 diabetes has albuminuria or two or more features of metabolic syndrome, in which case it should be 130/80 mmHg".

In the US, the American Diabetes Association's (ADA) Standards of Care state the blood pressure target for adults with type 1 diabetes should be 140/90 mmHg and 130/80 mmHg for those who already have cardiovascular disease.

At the 79th ADA Scientific Sessions in San Francisco, California co-researcher Trevor Orchard highlighted that the children's target is 120/80, claiming that it is "non-representative of the risk change" for this goal to rise to 140/90 after the age of 21.

"Our researchers were intrigued by the findings suggesting that blood pressure and glycemia are similarly important for cardiovascular risk prediction in this type 1 diabetes patient group," said lead study author Jingchuan Guo, postdoctoral fellow at the Center for Pharmaceutical Policy and Policy at the University.

"Since blood pressure control is likely to be as important as glucose control for cardiovascular risk prevention in people with type 1 diabetes, the initial treatment focus should be on glucose control, when HbA1c is very high, but as HbA1c approaches the high-normal range, an increasing focus on blood pressure becomes critical."

People with type 1 diabetes can keep blood pressure under control by eating a healthy diet low in sugar, maintaining healthy blood glucose levels, getting regular exercise, avoiding smoking and cutting down on alcohol.
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