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Lowering BP risky for patients with diabetes, heart disease | A University of Florida researcher has urged caution in reducing blood pressure in patients with diabetes and coronary disease. According to Rhonda Cooper-DeHoff,
an associate professor of pharmacy and medicine at UF, new data show an increased
risk of heart attack, stroke or death for patients having blood pressure deemed
too high or too low. She suggests raising the systolic bar above 120 for blood
pressure in patients with diabetes and coronary artery disease, saying that levels
between 130 and 140 appear to be the most healthful. Based on hypertension treatment
guidelines, doctors have assumed that with regard to blood pressure, "the lower,
the better," Cooper-DeHoff said. But, The International Verapamil SR-Trandolapril
study, known as INVEST, suggests that the range considered normal for healthy
Americans may actually be risky for those with a combined diagnosis of diabetes
and coronary artery disease. Cooper-DeHoff said: "Our data suggest that in patients
with both diabetes and coronary artery disease, there is a blood pressure threshold
below which cardiovascular risk increases." Nearly two out of three adults with
diabetes have high blood pressure. Normal blood pressure as defined by the American
Heart Association is less than 120 systolic and less than 80 diastolic. Blood
pressure greater than 140 is still associated with a nearly 50 percent increase
in cardiovascular risk in patients with diabetes. But efforts to reduce systolic
blood pressure to below 130 did not appear to offer any additional benefit to
diabetics with coronary artery disease compared with reduction of systolic blood
pressure to between 130 and less than 140. Cooper-DeHoff's research reveals for
the first time that this group of patients also had a similar increase in risk
when their blood pressure was controlled to lower than 115 systolic - the range
recommended as normal by the American Heart Association. Stephan Brietzke, an
endocrinologist who did not participate in the research, said Cooper-DeHoff's
findings parallel recent studies looking at blood sugar control, which suggest
a U-shaped curve with higher cardiovascular risks at both "too high" and "too
low" extremes. Cooper-DeHoff's presented the findings of her study on March 14
at the American College of Cardiology's 59th annual scientific session in Atlanta.
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