Attempted Forced Titration of Blood Pressure to <130/85 mm Hg in Type 2 Diabetic Hypertensive Patients in Clinical Practice: The Diastolic Cost

The authors assessed the practicality and results of forced titrating of blood pressure to <130/85 mm Hg based on guidelines of the sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in the setting of a clinical practice in 257 diabetic, hypertensive patients. Goal diastolic pressure was achieved in 90% of the patients, but goal systolic pressure was achieved in only 33%. In 57% of the patients, the attained diastolic pressure was ≤70 mm Hg, and in 20% of the cohort diastolic pressure was reduced to <70 mm Hg (mean, 60±1 mm Hg). Patients with final diastolic pressure <70 mm Hg were older, had a higher prevalence of coronary artery disease, and higher initial systolic and pulse pressures compared with patients with final diastolic pressure of 71–85 mm Hg. Thus, attempted lowering of blood pressure to <130/85 mm Hg is associated with excessive lowering of diastolic pressure in a significant number of patients. Whether the benefits of tight systolic control outweigh the risks of excessive diastolic reduction requires further prospective assessment. (J Clin Hypertens. 2006;8:29–34) © 2006 Le Jacq Ltd.