What evidence exists regarding the effect of reducing blood pressure in patients with diabetes?
Several meta-analyses have provided evidence that reducing blood pressure in patients with diabetes is associated with reduced risk of cardiovascular events, mortality, and end-stage kidney disease. Ettehad et al. reported that the reduction in major cardiovascular events was proportional to the blood pressure reduction achieved among trial participants with diabetes. Malhotra et al. found no evidence of heterogeneity in beneficial effects on mortality with respect to the presence or absence of diabetes. Brunström et al. conducted a systematic review and meta-analysis of randomized controlled trials that included at least 100 patients with diabetes, and found that blood pressure reduction decreased myocardial infarction, stroke, cardiovascular mortality, end-stage kidney disease, and all-cause mortality if baseline systolic blood pressure was greater than 150mmHg. However, paradoxically, increased cardiovascular mortality was observed if baseline systolic blood pressure was less than 140mmHg.  