Effect of Diuretic-Based Antihypertensive Treatment on Cardiovascular Disease Risk in Older Diabetic Patients with Isolated Systolic Hypertension

Curb, J. David; Pressel, Sara L.; Cutler, Jeffrey A.; Savage, Peter J.; Applegate, William B.; Black, Henry; Camel, Greta H.; David, Barry R.; Frost, Petter; Gonzalez, Nelly; Guthrie, Gordon P.; Oberman, Albert; Rutan, Gale H.; Adams, A. P.

doi:10.1097/00132586-199712000-00060

Cited by 80 publications

(110 citation statements)

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“…12 Less clear is why the relative risk of DM as a CVD risk factor has not changed. Clinical trial data for CVD risk factor control suggest that individuals with DM have higher absolute reductions in CVD outcomes than nondiabetic individuals when treated for hypertension 26 and dyslipidemia. 27,28 However, in the setting of acute coronary syndrome, individuals with DM fare worse than individuals without DM.…”

Section: Discussionmentioning

confidence: 99%

Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus

et al. 2007

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Background-Marked reductions in cardiovascular disease (CVD) morbidity and mortality have occurred in the UnitedStates over the last 50 years. We tested the hypothesis that the relative burden of CVD attributable to diabetes mellitus (DM) has increased over the past 5 decades. Methods and Results-Participants aged 45 to 64 years from the Framingham Heart Study, who attended examinations in an "early" time period (1952 to 1974), were compared with those who attended examinations in a later time period (1975 to 1998). The risk of CVD events (nϭ133 among those with and 1093 among those without DM) attributable to DM in the 2 time periods was assessed with Cox proportional hazards models; population attributable risk of DM as a CVD risk factor was calculated for each time period. The age-and sex-adjusted hazard ratio for DM as a CVD risk factor was 3.0 (95% CI, 2.3 to 3.9) in the earlier time period and 2.5 (95% CI, 1.9 to 3.2) in the later time period. The population attributable risk for DM as a CVD risk factor increased from 5.4% (95% CI, 3.8% to 6.9%) in the earlier time period to 8.7% (95% CI, 5.9% to 11.4%) in the later time period (P for attributable risk ratioϭ0.04), although multivariable adjustment resulted in attenuation of these findings (Pϭ0.12); most of these observations were found among men. Conclusions-The proportion of CVD attributable to DM has increased over the past 50 years in Framingham. These findings emphasize the need for increased efforts to prevent DM and to aggressively treat and control CVD risk factors among those with DM.

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Section: Discussionmentioning

confidence: 99%

Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus

et al. 2007

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“…30 Results from the Systolic Hypertension in the Elderly Patient (SHEP) study have shown that chlorthalidone therapy (doses 12.5 to 25 mg) was twice as effective in preventing cardiovascular events in diabetics than in nondiabetic hypertensive patients. 31 In clinical practice, it is almost impossible to control blood pressure in diabetic patients without the use of diuretics. Most frequently, thiazides have to be replaced by more potent loop diuretics to control blood pressure, especially when renal damage progresses.…”

Section: Diureticsmentioning

confidence: 99%

Treatment of Obesity Hypertension and Diabetes Syndrome

2001

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Abstract-Obesity has been shown to be an independent risk factor for coronary heart disease. The insulin resistance associated with obesity contributes to the development of other cardiovascular risk factors, including dyslipidemia, hypertension, and type 2 diabetes. The coexistence of hypertension and diabetes increases the risk for macrovascular and microvascular complications, thus predisposing patients to cardiac death, congestive heart failure, coronary heart disease, cerebral and peripheral vascular diseases, nephropathy, and retinopathy. Body weight reduction increases insulin sensitivity and improves both blood glucose and blood pressure control. Metformin therapy also improves insulin sensitivity and has been associated with decreases in cardiovascular events in obese diabetic patients. Antihypertensive treatment in diabetics decreases cardiovascular mortality and slows the decline in glomerular function. However, pharmacological treatment should take into account the effects of the antihypertensive agents on insulin sensitivity and lipid profile. Diuretics and ␤-blockers are reported to reduce insulin sensitivity and increase triglyceride levels, whereas calcium channel blockers are metabolically neutral and ACE inhibitors increase insulin sensitivity. For the high-risk hypertensive diabetic patients, ACE inhibition has proven to confer additional renal and vascular protection. Because hypertension and glycemic control are very important determinants of cardiovascular outcome in obese diabetic hypertensive patients, weight reduction, physical exercise, and a combination of antihypertensive and insulin sensitizers agents are strongly recommended to achieve target blood pressure and glucose levels.

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“…There is strong evidence from clinical trials of the value of treating hypertension in the elderly (269). There is less evidence for lipid-lowering and aspirin therapy, although the benefits of these interventions for primary and secondary prevention are likely to apply to older adults whose life expectancies equal or exceed the timeframes seen in clinical trials.…”

Section: Older Adults Recommendationsmentioning

confidence: 99%

Standards of Medical Care in Diabetes — 2009: American Diabetes Association

Cunha‐Vaz¹

2010

Diabetic Retinopathy

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Effect of Diuretic-Based Antihypertensive Treatment on Cardiovascular Disease Risk in Older Diabetic Patients with Isolated Systolic Hypertension

Cited by 80 publications

References 0 publications

Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus

Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus

Treatment of Obesity Hypertension and Diabetes Syndrome

Standards of Medical Care in Diabetes — 2009: American Diabetes Association

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