What is the most appropriate target SBP in persons with hypertension and diabetes mellitus?

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In this issue, Ó Hartaigh et al.[1] use data from the action to control cardiovascular risk in diabetes blood pressure (ACCORD BP) trial to test whether achieving target SBP less than 120 mmHg (intensive group) or less than 140 mmHg (standard group) lowers the risk of major adverse cardiovascular events (MACE) in persons with hypertension and diabetes mellitus [2]. The major finding was that, after adjustment for other statistically significant predictors of MACE, there was no significant reduction in the risk of MACE in those in the intensive group who achieved SBP less than 120 mmHg versus those who did not, whereas in the standard group, those who achieved the target SBP less than 140 mmHg had a significant (35–53%) reduction in the risk of MACE compared with those who maintained SBP more than 140 mmHg. The authors conclude that achieving a SBP goal of 120–140 mmHg is beneficial in reducing the risk of cardiovascular disease (CVD) outcomes in persons with hypertension and diabetes mellitus, whereas achieving SBP less than 120 mmHg does not further mitigate the risk of CVD outcomes.

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