US/EU relaxation of diabetes blood pressure lowering guidelines ignore evidence, threaten UK treatment
US/EU relaxation of diabetes blood pressure lowering guidelines ignore evidence, threaten UK treatment.
New research says recent changes to some guidelines affecting UK diabetes patients need to be reconsidered.
New research appearing today in the Journal of American Medical Association indicates that starting blood pressure lowering in diabetes patients with mildly elevated blood pressure and treating it more aggressively provides important health benefits such as reduced risk of stroke and diabetic eye disease.
In one of the most comprehensive systematic reviews of research in this area, researchers from The George Institute for Global Health, affiliated with the Oxford Martin School at Oxford University, are challenging recent changes to US and European guidelines that have relaxed previous recommendations of lower blood pressure targets in people with diabetes.
Globally, it is estimated that about 400 million people have diabetes putting them at high risk of heart disease, stroke, kidney disease and eye disease. In the UK, where about 2.5 million people have the condition, diabetes is a leading cause of kidney disease and blindness.
Urging for guidelines around the world to reflect the new findings, author Professor Kazem Rahimi of The George Institute United Kingdom and The University of Oxford said this research provides fundamental evidence about how blood pressure should be treated in people with diabetes.
“Although we did not see beneficial effects on risks of death and heart disease with lower blood pressure targets, our analyses indicate that many patients with diabetes and low-normal blood pressure levels will still benefit from blood pressure lowering, by reducing their risks of stroke, diabetic eye disease and early kidney disease,” says Professor Rahimi. “Unfortunately, recent US and EU changes to the guidelines will negatively impact the treatment options for people with diabetes in the UK. We urgently call for these recent changes to guidelines to be modified and for all guidelines around the world to consistently reflect the evidence so patients with diabetes are receiving the best possible treatment.”
“When considering blood pressure targets in these patients, it’s critical to make an individualised assessment of the balance between the benefits of more intensive treatment and any adverse effects of increasing medication,” says co-author of the paper and Chief Scientist of The George Institute for Global Health, Professor Anushka Patel. “This research indicates that many people with diabetes may have net benefits with more aggressive treatment.”
Blood pressure and diabetes expert, Professor Neil Poulter from Imperial College London said the increasing prevalence of diabetes globally and across Europe is an “unfolding nightmare” and that treatment recommendations need to reflect the best available evidence.
Professor Poulter, who was not involved in the study, said he was very pleased the review had been carried out. “I expect this study to influence guidelines for the treatment of people with diabetes, and for this to translate to appreciable effects on the health of people with diabetes.”
“I have been increasingly concerned about the trend to advocate higher blood pressure targets as reflected by recent changes to guidelines in Europe and the US and this study provides the evidence needed to reconsider this.”
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Maya Kay, Communications Manager Australia
The George Institute for Global Health
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