Test Your Knowledge Answer #499

The best answer is: C

Begin therapy with a blood pressure-lowering agent, with the goal of reducing blood pressure to ≤120/80 mmHg.

Hypertension and dyslipidemia are the two most important factors that need to be treated to reduce cardiovascular risk in patients with Type 2 diabetes [Grundy SM et al. Circulation. 2004;110;227-239].

These risk factors must be managed effectively and aggressively. For this patient, instituting antihypertensive therapy that normalizes her blood pressure is consistent with current guidelines. This approach has also been validated in clinical studies, such as STENO-2. In this study, 160 patients with Type 2 diabetes and persistent microalbuminuria were randomized to intensive, multifactorial treatment or conventional therapy. Over the mean treatment period of 7.8 years, patients in the intensive therapy group, which targeted systolic and diastolic blood pressure, cholesterol, triglycerides, and HbA1c, showed a marked reduction in cardiovascular risk. Over 13 years, intensive therapy was also associated with a significant reduction in the risk of death compared with conventional therapy (HR, 0.54; 95% CI, 0.32-0.89; P = .02).

Gæde P et al. N Engl J Med. 2003;348:383-393