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 .
The PHARAO study: prevention of hypertension with the angiotensin-converting enzyme inhibitor ramipril in patients with high-normal blood pressure – a prospective, randomized, controlled prevention trial of the German Hypertension League
Background The prevention of hypertension with the angiotensin-converting enzyme inhibitor ramipril in patients with high-normal blood pressure study addresses the issue of whether progression to manifest hypertension in patients with high-normal blood pressure can be prevented with treatment . Methods A total of 1008 participants with high-normal office blood pressure were r and omized to ramipril treatment group ( n = 505 ) and a control group ( n = 503 ) . The patients were followed up for 3 years . Primary endpoint was to prevent or delay the progression to manifest hypertension . Secondary endpoints were reduction in the incidence of cerebrovascular and cardiovascular events , as well as the development of hypertension as defined by ambulatory blood pressure monitoring . Findings One hundred and fifty-five patients ( 30.7 % ) in the ramipril group , and 216 ( 42.9 % ) in the control group reached the primary endpoint ( relative risk reduction 34.4 % , P = 0.0001 ) . Ramipril also proved to be more effective in reducing the incidence of manifest office hypertension in patients with baseline ambulatory blood pressure monitoring high-normal blood pressure . The incidence of cerebrovascular and cardiovascular events showed no statistically significant differences between the two groups . Cough was more frequent in the ramipril group ( 4.8 vs. 0.4 % ) . Interpretation There is now good clinical evidence that patients with high-normal blood pressure ( prehypertension ) are more likely to progress to manifest hypertension than patients with optimal or normal blood pressure . Additional ambulatory blood pressure monitoring seems to be essential to achieve correct diagnosis . Treatment of patients with high-normal office blood pressure with the angiotensin-converting enzyme inhibitor was well tolerated , and significantly reduced the risk of progression to manifest hypertension
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 .