Abstract
Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) the other risk factor for atherosclerosis, were cross-sectionally investigated. Methods: The association between the blood pressure control and the clinical characteristics was evaluated in 1359 patients with type 2 diabetes mellitus. Results: The number of antihypertensive agents was 1.5 ± 1.4 (2.0 ± 1.2 among the 990 patients with hypertension). The proportion of patients taking no antihypertensive agents was 29%, 22% were taking one, 29% were taking two and 21% of the patients were taking three or more antihypertensive agents. The value of the ankle-brachial pressure index significantly decreased with the increase in the number of antihypertensive agents even if the blood pressure was corrected to the target value. The values of brachial-ankle pulse wave velocity and carotid intima-media thickness were also increased. The prevalence of risk factors for atherosclerosis, such as obesity, hyperlipidemia, chronic kidney disease, hyperuricemia and anemia was significantly elevated with the number of agents. Conclusions: The number of antihypertensive agents simply reflects the grade and risk of atherosclerosis in patients with type 2 diabetes mellitus.
Highlights
It is well-recognized that atherosclerotic diseases are common in patients with type 2 diabetes mellitus
We consider that these results indicate the necessity of a more aggressive approach for the diabetic patients requiring intensive therapy for hypertension independently from the blood pressure control
The number of antihypertensive agents reflected the grade of atherosclerosis according to the values of the ankle-brachial pressure index (ABI), brachialankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT), regardless of the control of blood pressure in the patients with type 2 diabetes mellitus
Summary
It is well-recognized that atherosclerotic diseases are common in patients with type 2 diabetes mellitus. Hypertension is an independent risk factor for atherosclerosis, but is common in the type 2 diabetic patients [1,2]. When examining patients with hypertension resistant to antihypertensive agents, it is important to re-evaluate the various causes such as lifestyle, body weight, smoking habit and excessive alcohol consumption, in addition to re-considering the medication. These are risk factors for cardiovascular diseases, as well as hypertension and diabetes [6,7], it is possible that subjects requiring the combination therapy with antihypertensive agents may have advanced atherosclerosis. The associations of cardiovascular events with the level of blood pressure achieved by medication or with the type of antihypertensive agents used have been reported previously [3,6,7,11,12,13], the relationship between atherosclerosis and the number of antihypertensive drugs required in the clinical setting has not yet been investigated
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