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To the Editor: The JNC 7 report¹ recommended a blood pressure goal of 130/85 mm Hg for patients with diabetes. None of the larger controlled studies^2-5 of hypertension in patients with diabetes mellitus, however, achieved a mean systolic blood pressure of less than 140 mm Hg, despite intensive treatment. Thus, although the JNC 7 guidelines seem to provide a reasonable goal, there is no evidence that this is achievable despite treatment with several antihypertensive medications. The recommended blood pressure goal of 135/80 mm Hg by the American College of Physicians⁶ seems more reasonable and realistic.

G. Divakara Murthy, MD
General Internal Medicine/Primary Care
Stratton VA Medical Center
Albany, NY

1. Chobanian AV, Bakris GL, Black HR, et al, and the National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-2572. FREE FULL TEXT 2. Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension: Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA. 1996;276:1886-1892. FREE FULL TEXT 3. Tuomilehto J, Rastenyte D, Birkenhager WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension: Systolic Hypertension in Europe Trial Investigators. N Engl J Med. 1999;340:677-684. FREE FULL TEXT 4. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703-713. FREE FULL TEXT 5. Hansson L, Zanchetti A, Carruthers SG, et al, for HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet. 1998;351:1755-1762. FULL TEXT | WEB OF SCIENCE | PUBMED 6. Snow V, Weiss KB, Mottur-Pilson C, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. The evidence base for tight blood pressure control in the management of type 2 diabetes mellitus. Ann Intern Med. 2003;138:587-592. FREE FULL TEXT

JAMA. 2003;290:1313.

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