CONCLUSIONS Antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with diabetes mellitus and a systolic blood pressure more than 140 mm Hg .
If systolic blood pressure is less than 140 mm Hg , however , further treatment is associated with an increased risk of cardiovascular death , with no observed benefit
OBJECTIVE To assess the effect of antihypertensive treatment on mortality and cardiovascular morbidity in people with diabetes mellitus , at different blood pressure levels .
Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study
Background Hypertension guidelines advise aggressive blood pressure ( BP ) lowering in patients with diabetes or high cardiovascular risk , but supporting evidence is limited . We analysed the impact of BP on cardiovascular events in well treated high-risk patients enrolled in a large clinical trial ( Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial ) . Methods Twenty-five thous and five hundred and eighty-eight patients with atherosclerotic disease or diabetes with organ damage , tolerant to angiotensin-converting enzyme inhibitors , were r and omized to ramipril , telmisartan or both . We related the primary composite outcome and its components to : baseline SBP ; SBP changes from baseline to event ; and average in-trial SBP . Results The risk of myocardial infa rct ion did not increase with baseline SBP and was unaffected by subsequent SBP change . In contrast , stroke risk progressively increased with baseline SBP ( P for trend < 0.0001 ) and decreased with reduction . In patients with  baseline SBP  less than 130 mmHg , adjusted for several covariates , cardiovascular mortality increased with further SBP reduction ( P < 0.0001 ) . A J-curve ( nadir around 130 mmHg ) occurred in the relationship between in-treatment SBP and all outcomes except stroke . Conclusion In high-risk patients , the benefits from SBP lowering below 130 mmHg are driven mostly by a reduction of stroke ; myocardial infa rct ion is unaffected and cardiovascular mortality is unchanged or increased . Future trials should be design ed to test the value of SBP lowering in high-risk patients with SBP in the range of 130–150 mmHg
CONCLUSIONS Antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with diabetes mellitus and a systolic blood pressure more than 140 mm Hg .
If systolic blood pressure is less than 140 mm Hg , however , further treatment is associated with an increased risk of cardiovascular death , with no observed benefit
OBJECTIVE To assess the effect of antihypertensive treatment on mortality and cardiovascular morbidity in people with diabetes mellitus , at different blood pressure levels .