A new study suggests that type 2 diabetics who want to avoid heart attacks or strokes should rigorously control their blood pressure. Doing so for an extended period of time seems to pay off years later.
Tight control of blood glucose levels, on the other hand, didn’t seem to have similar benefits for the subjects in the study. This finding may seem counterintuitive, given all that we know about the benefits of keeping A1C levels low. However, digging into the research gives us some clues about what’s going on here.
The patients followed by researchers had already completed an intensive, five-year clinical trial lowering blood pressure and blood sugar. That was called the ADVANCE trial, and it showed advantages to getting both numbers down. Scientists then wanted to find out if these benefits lasted after the trial was over. They followed the patients for nearly six more years.
There were long-lasting advantages for those who controlled their blood sugars. For one thing, they were less likely to have kidney problems or other complications from the disease
“Probably the five years of treatment we gave them led to changes in the kidney that continued to protect people for many years after,” said Dr. Bruce Neal, a professor of medicine at the University of Sydney in Australia and one of the researchers.
However, in handling heart attacks and stroke risk, it looked as though lowering blood pressure was the most effective treatment for the study’s patients over the long haul. The target numbers were 135/75, and patients saw continued — although reduced — benefits years later.
It’s important to note that the subjects involved were not type 1 diabetics. There is direct evidence that shows tight glucose control can improve their cardiovascular health. However, the people involved in this study weren’t even using insulin. They instead mostly took drugs called sulfonylureas. This older class of medication lowers blood sugars but has also been linked to increased issues with heart attacks and strokes.
According to Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York, this means that more recent drugs for type 2 diabetics might have more benefits. “These newer drugs seem to be much more friendly in terms of heart attacks and strokes,” he said.
Perhaps the study should be summed up this way: While keeping your blood sugar under control is great — for all diabetics — that’s not necessarily the end of the story. If you have other issues, like high blood pressure, it’s important to address them too. If it means taking another class of drugs to get those numbers down, so be it.
Chronic conditions like diabetes can be complicated to manage, so please consult with your health care providers and make informed decisions. It’s worthwhile advice for all of us,
The report appeared online last month in the New England Journal of Medicine.