Diabetes and hypertension.

Abstract

This article covers presentations and symposia dealing with the relation between diabetes and hypertension that were given at the 16th Scientific Meeting of the American Society of Hypertension, San Francisco, CA, 15–19 May 2001. At a symposium at the 16th Scientific Meeting of the American Society of Hypertension (ASH), San Francisco, CA, 15–19 May 2001, Willa Hsueh, Los Angeles, CA, discussed clinical trials in hypertension. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-VI, 1997, available at http://www.nhlbi.nih.gov/guidelines/hypertension/jnc6.pdf) defined essential hypertension as a blood pressure (BP) >140/90 mmHg, but Hsueh noted that only 25% of patients with hypertension have no complications such as renal disease, cardiac disease, obesity, diabetes, and hyperlipidemia. BP goals are lower for patients with such complications. In the JNC-VI, patients with diabetes were noted to be at high risk and were given a BP goal of 1 g proteinuria, the goal to lessen target organ damage was set at 125/75 mmHg. In the U.K. Prospective Diabetes Study (UKPDS) patients were treated with either an ACE inhibitor (ACEI) or β-blocker (BB) and achieved levels of 144/82 vs. 154/87 mmHg over 8 years. However, at a question-and-answer session after the lecture, it was noted that captopril was given only once or twice daily and therefore may not have had optimal benefit. Both treatments reduced microvascular end points of renal and eye disease, macrovascular end points, and congestive heart failure (CHF), which may in part reflect diabetic cardiomyopathy. The Hypertension Optimal Therapy (HOT) trial of 18,790 patients, of whom 8% had diabetes and were treated with felodipine followed by ACEI and then followed by additional agents, showed a clear relation of BP to cardiovascular disease (CVD) events in the diabetes subgroup when comparing …