Current status of aggressive blood glucose and blood pressure control in diabetic hypertensive subjects.

Uncontrolled diabetes mellitus (DM) is associated with high cardiovascular morbidity and mortality. The coexistence of hypertension and DM multiplies the diabetic complications manifold. Earlier studies have shown that lowering blood glucose, blood pressure (BP), or both decreases the diabetic complications. On the basis of these results, national and international guidelines have recommended aggressive blood glucose and BP control in patients with DM to glycosylated hemoglobin <7.0% and BP <130/80 mm Hg. However, several recent clinical outcomes trials have demonstrated that lowering glycosylated hemoglobin to <7.0% and BP to <130/80 mm Hg does not add any additional benefit to patients with DM and hypertension and may be detrimental to their health. The consensus of scientific opinion at present is that BP should be reduced to 130 to 139/70 to 80 mm Hg in patients with DM with increased cardiovascular risk. The investigators conducted a Medline search of English-language papers published from 1998 to 2010 regarding aggressive blood glucose and BP control in patients with DM and hypertension, and 15 pertinent reports were selected. In conclusion, a review of recent research findings suggests less aggressive control of glucose and BP, and "the lower the better" may not be defensible at present, until new data become available.