Hypertension as a risk factor in non-insulin-dependent diabetes mellitus: How far should blood pressure be reduced?

Abstract

C ardiovascular complications are the commonest cause of excess mortality in type II diabetes, and, of the acknowledged contributory factors that promote the development of such complications, hypertension is of particular importance in this condition. Depending on age and gender, some 30%-60% of patients already present with hypertension on first being diagnosed with diabetes. If proteinuria develop as a sign of nephropathy, the prevalence of hypertension rises to 90%. Presence of proteinuria side by side, with hypertension is associated with the highest level of mortality among type II diabetics.‘,2 In hypertensive type I diabetic patients, in whom hypertension usually develop as a consequence of diabetic nephropathy, lowering of the blood pressure to somewhere near the lower end of the normal range is a generally accepted treatment option. No such general recommendation can be made for hypertensive type II diabetic patients, as this patient group varies widely in composition. Effectively, the factors that must generally be taken into account in the treatment of high blood pressure are the patient’s age and life expectancy, and the presence of any concomitant and secondary conditions. Various studies in elderly hypertensives have shown that even a moderate lowering of blood pressure results in an improved quality of life through the avoidance of severe arteriosclerotic complications, and also in an improved prognosis3s4 Thus, in the Swedish Trial in Old Patients (STOP) study> 1627 patients aged between 70 and 84 years were treated double blind with a thiazide diuretic, a