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Recent clinical trials and guidelines suggest that patients with diabetes should be treated with multiple antihypertensives to achieve blood pressure target goals in order to reduce risk of cardiovascular disease.
In his new report, L. Michael Prisant, MD, with the Hypertension and Clinical Pharmacology Unit at the Medical College of Georgia, Augusta, United States, reviewed guidelines and recent clinical trial data regarding patients with diabetes.
"The treatment goals for patients with diabetes are rigorous," he states. Guidelines advocate titrating drugs to a target blood pressure less than 130/80 mmHg in patients without significant diabetic nephropathy, while in patients with gross nephrotic syndrome, the treatment goal is a systolic blood pressure less than 125 mmHg and a diastolic less than 75 mmHg.
Studies reviewed in his article include the United Kingdom Prospective Diabetes Study 38 (UKPDS), Systolic Hypertension in the Elderly Program (SHEP), Systolic Hypertension in Europe Trial (Sys-Eur Trial), Hypertension Optimal Treatment (HOT) Trial, Heart Outcomes Prevention Evaluation (HOPE) study, Reduction of Endpoints in Non-Insulin Dependent Diabetes Mellitus with the Angiotensin II Receptor Antagonist Losartan (RENAAL) trial, Irbesartan Reduction in Microalbuminuria (IRMA) trial, Irbesartan Diabetes Nephropathy Trial (IDNT), MICRO-HOPE, and losartan intervention for endpoint (LIFE) reduction in hypertension trial.
Data from these trials have suggested that low-dose diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and dihydropyridine calcium antagonists reduce cardiovascular events in patients with diabetes.
In addition, in patients with diabetic renal disease, angiotensin receptor blockers appear to reduce the rate of end-stage renal disease, whereas dihydropyridine calcium antagonists show no benefit.
However, both ACE inhibitors and angiotensin receptor blockers (ARBs) appear to reduce overall mortality, cardiovascular events, and the development of overt nephropathy in high-risk patients with diabetes without advanced renal disease.
"The prevention of diabetes should be the future goal given the escalating incidence of type 2 diabetes mellitus caused by increasing obesity in the population," Dr. Prisant concludes.
"It has been proven that ACE inhibitors and ARBs and lifestyle changes, such as the reduction of weight, total intake of fat, and intake of saturated fat and the addition of fiber and physical activity, are associated with lower rates of newly diagnosed diabetes," he adds. Am J Ther 2003;10:5:363-9.
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