diabetesDE and DDG recommend new guidelines

20.04.2010 16:34

Blood pressure in diabetics must not be too low

As part of diabetes therapy, diabetics often receive medication to keep their blood pressure low. Current study evaluations now show that it makes sense to set not only upper but also lower blood pressure limits.

This is particularly true for diabetics, emphasize the organization diabetesDE and the German Diabetes Society (DDG): They often suffer from narrowing of the coronary arteries. If your blood pressure drops too low, your heart will not receive enough supply.

Both high blood sugar levels as a result of diabetes and high blood pressure levels cause long-term damage to the blood vessels. They increase the risk of a stroke or heart attack. Monitoring blood pressure values and treating high blood pressure are therefore part of diabetes therapy. The DDG currently recommends a target blood pressure that should not be higher than 130 to 80 milligrams of mercury (mm Hg) at rest.

In healthy people, a blood pressure of 120:80 is optimal. Even a little less usually doesn't hurt. However, for people with narrowing of the coronary arteries, including many diabetics, an upper value of 120 may be too low. Above all, a drop in the lower value below 75 must be avoided. This lower value indicates the blood pressure during relaxation of the heart, known as diastole.

In this phase, the heart muscle is supplied with fresh oxygen-rich blood via the coronary arteries. If blood pressure drops too low in diastole, the blood supply to the heart can be impaired.

Because of the narrowing in the coronary arteries, affected diabetics need a “reserve” so to speak. Otherwise complications could arise. This is suggested by evaluations of some studies, as diabetes experts now explain in a current statement from diabetesDE and DDG. One of these studies is the ACCORD study. Participants were almost 5,000 diabetics with elevated blood pressure.

For half of the participants, the goal was to lower their upper blood pressure to below 140. The other half aimed for values below 120. The lower target value did not result in an increase in deaths or heart attacks. However, there were increased side effects of the therapy.

These included severe drops in blood pressure with brief loss of consciousness, slowing of the heartbeat and electrolyte disturbances or kidney weakness. Other study results also suggest that low blood pressure increases the risk of complications in people with narrowing of the coronary arteries.

The European Society of Hypertension (ESH) has therefore recently reassessed its recommendations. In their current statement, diabetesDE and DDG also recommend a target blood value of 130-140/80-85 mmHg, although 130/80 mmHg is still optimal. Long-term elevated blood pressure in diabetics still means a high risk of cardiovascular disease.