Diabetes, Hypertension, and Outcome Studies: Overview 2010

Abstract

The treatment of hypertension in type 2 diabetes is of great importance in avoiding costly complications and human suffering. The evidence base for recommending a treatment target for blood pressure control has expanded as the result of the publication of new studies in 2010, which will be summarized and commented on in this overview. Hypertension is a leading risk factor for mortality in both developing and developed countries (1) and a well established risk factor for cardiovascular disease (CVD) in patients with diabetes (2). An observational analysis from the UK Prospective Diabetes Study (UKPDS) has demonstrated a linear relationship between mean in-study systolic blood pressure (SBP) and the risk of macro- and microvascular complications (3). Tighter blood pressure control in hypertensive patients with type 2 diabetes by use of several antihypertensive drug classes versus placebo has been reported to reduce the risk of both micro- and macrovascular disease in the UKPDS (4,5) as well as several other intervention studies (6–9). Guidelines have so far advocated a treatment target blood pressure of <130/80 mmHg for patients with type 2 diabetes (10–12). However, the 2009 European guidelines from the European Society of Hypertension (ESH) recommend that patients with diabetes lower their SBP well below 140 mmHg—without mentioning a specific lowest target (13)—against a background of the lower blood pressure goals (<130/80 mmHg) recommended for patients with diabetes, which have never really been achieved in any single large trial and are even more rarely attained in medical practice. This ESH recommendation was also based on the results in some trials (14,15) and post hoc analyses of high-risk hypertensive patients (16,17), as in the Ramipril Global Endpoint Trial (ONTARGET) post hoc study (18,19) of high-risk patients (49% with a previous coronary …