PSUN158 INTENSIVE VS. CONVENTIONAL BLOOD PRESSURE GOALS IN OLDER PATIENTS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND: Hypertension is a major cardiovascular risk factor that affects over 50% of individuals with type 2 diabetes. Lowering blood pressure to reduce the risk of micro- and macrovascular complications of diabetes is a strong recommendation advocated by contemporary clinical practice guidelines, however, proposed goals for older patients with diabetes are heterogeneous and rely on indirect evidence as they are frequently underrepresented in clinical trials. Herein, the optimal blood pressure goal and its associated risks remain uncertain in this population. OBJECTIVE: To assess the effect of intensive vs conventional blood pressure goals on patient important outcomes in older adults with type 2 diabetes. METHODS: A comprehensive search was performed using MEDLINE, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled trials, and Cochrane Database of Systematic Reviews, from database inception to March 2021. Randomized controlled trials comparing intensive vs conventional blood pressure goals in adults over 60 years of age with type 2 diabetes were included. Screening and data extraction were performed independently and in duplicate. Modified Mantel-Haenszel meta-analyses were conducted to estimate odds ratios (OR) for dichotomous outcomes and mean differences for continuous outcomes, alongside 95% confidence intervals (CIs). (PROSPERO registration number: CRD42019126078) RESULTS: Seven trials fulfilled our inclusion criteria.A 19% risk reduction (OR 0.81; 95% CI 0.69 to 0.95; I(2)= 8%; p= 0.35) in the occurrence of major adverse cardiovascular events (MACE) and 37% risk reduction (OR 0.63; 95% CI 0.51 to 0.79; I(2)= 0%; p= 0.56) in the occurrence of fatal or non-fatal stroke was documented in the intensive treatment group. There were no differences in the occurrence of all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and peripheral vascular disease. Data regarding treatment adverse effects and microvascular outcomes were scarcely reported among included studies. CONCLUSION: In summary, our analysis provides evidence that intensive blood pressure goals in older patients with diabetes are associated with a lower risk of stroke and MACE. Nevertheless, data are very scarce regarding microvascular diabetes outcomes and treatment safety. Given that an intensive approach would increase the number of medications, cost, adverse events and probably decrease adherence, treatment of hypertension in this population should be conducted with a shared decision making approach that makes sense from an intellectual, emotional, and practical basis. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.