Treatment Of Hypertension In Type Research Articles

Diabetes, Hypertension, and Outcome Studies: Overview 2010

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 …

Efficacy of manidipine/delapril versus losartan/hydrochlorothiazide fixed combinations in patients with hypertension and diabetes

Hypertension markedly increases the already high risk for cardiovascular complications in patients with diabetes mellitus. Less than one in eight patients with hypertension and type 2 diabetes have adequately controlled blood pressure. As a result, antihypertensive combinations are now widely used in management of hypertension associated with diabetes. This double-blind study investigated efficacy of a new fixed dose combination of a calcium antagonist, manidipine 10 mg, and an angiotensin-converting enzyme inhibitor, delapril 30 mg, compared with a combination of an angiotensin receptor blocker, losartan 50 mg, and a diuretic, hydrochlorothiazide 12.5 mg. Patients with hypertension (blood pressure > or = 130/80 mmHg) with controlled type 2 diabetes (HbA1c < or = 7.5%) were randomized to manidipine/delapril (n = 153) or losartan/hydrochlorothiazide (n = 161), administered once daily for 12 weeks. Patients underwent ambulatory blood pressure monitor evaluation at baseline and end of treatment. Mean decreases in 24-h systolic blood pressure were seen with both manidipine/delapril (-9.3 mmHg) and losartan/hydrochlorothiazide (-10.7 mmHg) combinations. The mean (95% confidence interval) treatment difference was -1.4 (-4.5/1.8) mmHg, demonstrating noninferiority of the manidipine/delapril combination. Reduction in 24-h diastolic blood pressure (-4.6 versus -4.5 mmHg) and daytime (systolic blood pressure -10.5 versus -11.1 mmHg) and night-time (systolic blood pressure -7.1 versus -9.3 mmHg) blood pressure were also not significantly different between treatments. Compliance and adverse events were comparable for both groups. The study demonstrated that the combination of manidipine and delapril is as effective as losartan and hydrochlorothiazide in treatment of hypertension in type 2 diabetes.

Lipid lowering targets are easier to attain than those for treatment of hypertension in type 2 diabetes

To assess the impact of therapeutic strategies to reduce cardiovascular risk in patients with type 2 diabetes. Five-hundred patients with type 2 diabetes were studied, using retrospective case note analysis in 1997 (followed by a unit policy targeting vascular risk) and again in 2001. The mean BP of the hypertensive patients was unchanged, 151/83 +/- 23/12 mmHg (1997) and 149/84 +/- 19.1/9.8 mmHg (P=0.2) (2001) (despite increase in patients receiving 23 antihypertensives (4.2% to 18.0%, P<0.01). The mean cholesterol improved from 5.34 +/- 1.1 mmol/L to 4.72 +/- 0.94 mmol/L (P<0.01). 2.9% compared with 44.6% (P<0.01) of hypercholesterolaemic patients, achieved target cholesterol. Antiplatelet therapy increased from 27.6% to 61.2% (P<0.01). Reduced mean HbA1c, 7.91 +/- 1.61% to 7.12 +/- 1.41% (P<0.01). Improved lipid profiles, aspirin uptake and glycaemic control, but no improvement in blood pressure targets were achieved. Additional strategies are required to achieve cardiovascular risk factor targets.

Treatment of hypertension reduces risk of complications in type 2 diabetes

Vijan S, Hayward RA. Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann Intern Med2003 ; 138 :...

Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care.

Hypertension in patients with type 2 diabetes mellitus is a prevalent condition that leads to substantial morbidity and mortality. To evaluate the goals and optimal agents for treatment of hypertension in type 2 diabetes. Review of the medical literature Randomized trials that evaluated the pharmacologic treatment of hypertension in patients with diabetes and reported microvascular and macrovascular outcomes. Studies were identified by using the Cochrane Library, MEDLINE, meta-analyses, review articles, and expert recommendation. The searches of the Cochrane Library and MEDLINE were performed in May 2000 and updated in April 2002. Data were abstracted to standardized forms by a single reviewer and were confirmed by a second reviewer. Treatment of hypertension in type 2 diabetes provides dramatic benefit. Target diastolic blood pressures of less than 80 mm Hg appear optimal; systolic targets have not been as rigorously evaluated, but targets of 135 mm Hg or less are reasonable. Studies that compare drug classes do not suggest obviously superior agents. However, it is reasonable to conclude that thiazide diuretics, angiotensin-II receptor blockers, and perhaps angiotensin-converting enzyme (ACE) inhibitors may be the preferred first-line agents for treatment of hypertension in diabetes. beta-Blockers and calcium-channel blockers are more effective than placebo, but they may not be as effective as diuretics, angiotensin-II receptor blockers, or ACE inhibitors; however, study results are inconsistent in this regard. Treatment of hypertension in type 2 diabetes, with blood pressure goals of 135/80 mm Hg, provides dramatic benefits. Thiazide diuretics, angiotensin II receptor blockers, and ACE inhibitors may be the best first-line treatments, although other agents are usually necessary and goals may not be achieved even with three or four agents. Aggressive blood pressure control may be the most important factor in preventing adverse outcomes in patients with type 2 diabetes.

Treatment of hypertension in type 2 diabetes mellitus--2002 update

Arterial hypertension and diabetes are potent independent risk factors for cardiovascular, cerebral, renal and peripheral (atherosclerotic) vascular disease. The prevalence of hypertension in diabetic individuals is approximately twice that in the non-diabetic population. Diabetic individuals with hypertension have a greater risk of macrovascular and microvascular disease than normotensive diabetic individuals. Hypertension is a major contributor to morbidity and mortality in diabetes, and should be recognized and treated early. Type 2 diabetes and hypertension share certain risk factors such as overweight, visceral obesity, and possibly insulin resistance. Life-style modifications (weight reduction, exercise, limitation of daily alcohol intake, stop smoking) are the foundation of hypertension and diabetes management as the definitive treatment or adjunctive to pharmacological therapy. Additional pharmacological therapy should be initiated when life-style modifications are unsuccessful or hypertension is too severe at the time of diagnosis. All classes of antihypertensive drugs are effective in controlling blood pressure in diabetic patients. For single-agent therapy, ACE-inhibitors, angiotensin receptor blocker, beta-blockers, and diuretics can be recommended. Because of concerns about the lower effectiveness of calcium channel blockers in decreasing coronary events and heart failure and in reducing progression of renal disease in diabetes, it is recommended to use these agents as second-line drugs for patients who cannot tolerate the other preferred classes or who require additional agents to achieve the target blood pressure. The choice depends on the patients specific treatment indications since each of these drugs have potential advantages and disadvantages. In patients with microalbuminuria or clinical nephropathy, both ACE-inhibitors and angiotensin receptor blockers are considered first line therapy for the prevention of and progression of nephropathy. Since treatment is usually life-long, cost effectiveness should be included in treatment evaluation.

Treatment of hypertension in type 2 diabetes.

Hypertension is one of the most common medical conditions in the United States, affecting 50 million American adults and accounting for one of four physician office visits. It is often undetected and undertreated, creating significant public health consequences. In diabetes, hypertension is an even greater problem, as diabetes has become the most common single cause of end-stage renal disease (ESRD) in the world, and diabetes is increasing in prevalence. The most important factor in slowing the decline of renal function in diabetes is aggressive treatment of hypertension. Recent guidelines have emphasized that the target blood pressure levels for patients with diabetes should be lower than in other hypertensive groups. The best specific approach for the treatment of hypertension in diabetic patients is the subject of much debate. It may be in the end that the specific drug choice has less overall importance than the actual attainment of adequate blood pressure control. In addition, more credence must be placed on the value of treating systolic hypertension than has traditionally been given. Coexisting diabetes and hypertension are a common clinical scenario that can set off a vicious cycle of increasing renal damage, rising blood pressure, and increased cardiovascular morbidity and mortality. Treatment often requires multiple drugs to effectively preserve renal function and prevent complications.