Abstract
Patients with diabetes mellitus and symptomatic coronary artery disease are also likely to be hypertensive and, overall, are at very high cardiovascular (CV) risk. This paper reports the findings of a posthoc analysis of the 1113 patients with diabetes mellitus in the ACTION trial: ACTION itself showed that outcomes in patients with stable angina and hypertension were significantly improved when a long-acting calcium channel blocking drug (nifedipine GITS) was added to their treatment regimens. This further analysis of the ACTION database in those patients with diabetes has identified a number of practical therapeutic issues which are still relevant because of potential outcome benefits, particularly in relation to BP control. For example, despite background CV treatment and, specifically, despite the widespread use of ACE Inhibitor drugs, the addition of nifedipine GITS was associated with significant benefits: improvement in BP control by an average of 6/3 mmHg and significant improvements in outcome. In summary, this retrospective analysis has identified that the addition of nifedipine GITS resulted in improved BP control and significant outcome benefits in patients with diabetes who were at high CV risk. There is evidence to suggest that these findings are of direct relevance to current therapeutic practice.
Highlights
The optimal management of patients with type 2 diabetes mellitus requires a multiplicity of drug treatments: for glycaemic control and for nephroprotection and for reducing cardiovascular (CV) risk
Attention is directly focused on the role of improved blood pressure (BP) control by means of the calcium channel blocking drug (CCB), nifedipine, which has well-recognised pharmacological properties known to lead to BP reduction, symptomatic improvement in angina, and amelioration of underlying myocardial ischaemia [15, 16]
Of 7665 patients started on study medication, 1113 (14.5%) were categorised with diabetes mellitus at baseline: the great majority, approximately 85%, were classified as patients with type 2 diabetes
Summary
The optimal management of patients with type 2 diabetes mellitus requires a multiplicity of drug treatments: for glycaemic control and for nephroprotection and for reducing cardiovascular (CV) risk. The ACTION trial (published in 2004) established that the addition of nifedipine (in its long-acting GITS formulation) improved the prognosis of patients with chronic stable angina, in those with concomitant hypertension [13, 14]. This further analysis addresses practical treatment issues in more than 1000 patients with high CV risk which was attributable to the combination of established CAD, diabetes, and hypertension. Attention is directly focused on the role of improved BP control by means of the calcium channel blocking drug (CCB), nifedipine, which has well-recognised pharmacological properties known to lead to BP reduction, symptomatic improvement in angina, and amelioration of underlying myocardial ischaemia [15, 16]
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