Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events

Návar, Ann Marie; Gallup, Dianne; Lokhnygina, Yuliya; Green, Jennifer B.; McGuire, Darren K.; Armstrong, Paul W.; Buse, John B.; Engel, Samuel S.; Lachin, John M.; Standl, Eberhard; Werf, Frans Van de; Holman, Rury R.; Peterson, Eric D.

doi:10.1161/hypertensionaha.117.09482

Cited by 13 publications

(4 citation statements)

References 18 publications

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“…Thus, diabetic patients with BP values near the upper limit of normal should be monitored for the development of hypertension, especially if they have a positive family history of hypertension and the phenotypic features of the metabolic syndrome. Since development of hypertension in patients with diabetes is marked by a significant increase in macrovascular and microvascular risk 2, 23 , efforts should be made to delay or ideally prevent the increase in BP. Obviously, the follow-up scheme of both MCDS and FOS does not reflect everyday clinical practice, as is generally true of observational population-based studies.…”

Section: Discussionmentioning

confidence: 99%

Hypertension and Diabetes Mellitus

et al. 2018

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Type 2 diabetes mellitus and hypertension overlap in the population. In many subjects, development of diabetes mellitus is characterized by a relatively rapid increase in plasma glucose values. Whether a similar phenomenon occurs during the development of hypertension is not known. We analyzed the pattern of blood pressure (BP) changes during the development of hypertension in patients with or without diabetes mellitus using data from the MCDS (Mexico City Diabetes Study; a population-based study of diabetes mellitus in Hispanic whites) and in the FOS (Framingham Offspring Study, a community-based study in non-Hispanic whites) during a 7-year follow-up. Diabetes mellitus at baseline was a significant predictor of incident hypertension (in FOS, odds ratio, 3.14; 95% confidence interval, 2.17-4.54) independently of sex, age, body mass index, and familial diabetes mellitus. Conversely, hypertension at baseline was an independent predictor of incident diabetes mellitus (in FOS, odds ratio, 3.33; 95% CI, 2.50-4.44). In >60% of the converters, progression from normotension to hypertension was characterized by a steep increase in BP values, averaging 20 mm Hg for systolic BP within 3.5 years (in MCDS). In comparison with the nonconverters group, hypertension and diabetes mellitus converters shared a metabolic syndrome phenotype (hyperinsulinemia, higher body mass index, waist girth, BP, heart rate and pulse pressure, and dyslipidemia). Overall, results were similar in the 2 ethnic groups. We conclude that (1) development of hypertension and diabetes mellitus track each other over time, (2) transition from normotension to hypertension is characterized by a sharp increase in BP values, and (3) insulin resistance is one common feature of both prediabetes and prehypertension and an antecedent of progression to 2 respective disease states.

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Section: Discussionmentioning

confidence: 99%

Hypertension and Diabetes Mellitus

et al. 2018

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“…155 Recent data suggest a U-shaped relationship between BP and cardiovascular outcomes in T2D, where systolic BP over 150 mmHg or less than 110 mmHg portends a poorer prognosis. 156 Maintenance of BP within this range appears to be the most appropriate strategy in T2D. In view of these and other large prospective studies evaluating BP-lowering targets in DM, current National Institute for Health and Care Excellence (NG28) recommendations are that BP be maintained below 140/80 mmHg in uncomplicated T2D or below 130/80 mmHg if there is a history of kidney, eye or cerebrovascular disease.…”

Section: Pharmacological Interventions To Reverse Cardiovascular Dysfmentioning

confidence: 99%

Diabetic cardiomyopathy: prevalence, determinants and potential treatments

Gulsin

Athithan

McCann

2019

Therapeutic Advances in Endocrinology

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The prevalence of type 2 diabetes (T2D) has reached a pandemic scale. These patients are at a substantially elevated risk of developing cardiovascular disease, with heart failure (HF) being a leading cause of morbidity and mortality. Even in the absence of traditional risk factors, diabetes still confers up to a twofold increased risk of developing HF. This has led to identifying diabetes as an independent risk factor for HF and recognition of the distinct clinical entity, diabetic cardiomyopathy. Despite a wealth of research interest, the prevalence and determinants of diabetic cardiomyopathy remain uncertain. This limited understanding of the pathophysiology of diabetic heart disease has also hindered development of effective treatments. Tight blood-glucose and blood-pressure control have not convincingly been shown to reduce macrovascular outcomes in T2D. There is, however, emerging evidence that T2D is reversible and that the metabolic abnormalities can be reversed with weight loss. Increased aerobic exercise capacity is associated with significantly lower cardiovascular and overall mortality in diabetes. Whether such lifestyle modifications as weight loss and exercise may ameliorate the structural and functional derangements of the diabetic heart has yet to be established. In this review, the link between T2D and myocardial dysfunction is explored. Insights into the structural and functional perturbations that typify the diabetic heart are first described. This is followed by an examination of the pathophysiological mechanisms that contribute to the development of cardiovascular disease in T2D. Lastly, the current and emerging therapeutic strategies to prevent or ameliorate cardiac dysfunction in T2D are evaluated.

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“…However, patients with more than one cardiovascular event were not reported separately [ 8 ]. Observational data from two recent trials of inhibitors of dipeptidyl-peptidase 4 have revealed U-shaped relationships between SBP and adjusted CVD rates in patients with type 2 diabetes and established cardiovascular disease or multiple risk factors [ 9 , 10 ] but did not evaluate the risk of death. In patients with diabetes and high cardiovascular risk who participated in the ONTARGET/TRANSCEND (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomised Assessment Study in Angiotensin Converting Enzyme Inhibitor Intolerant Subjects with Cardiovascular Disease) trials, on-treatment SBP less than 120 mmHg was associated with higher risk for cardiovascular events and for death, but that study excluded patients with symptomatic heart failure [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial

Wijkman

Claggett

Dı́az

et al. 2020

Cardiovasc Diabetol

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Background The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure. Methods We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization. Results Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99–1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04–1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86–1.04) P = 0.26; P for interaction 0.005). Conclusions The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration. Trial registration ClinicalTrials.gov number NCT01147250, first posted June 22, 2010

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Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events

Cited by 13 publications

References 18 publications

Hypertension and Diabetes Mellitus

Hypertension and Diabetes Mellitus

Diabetic cardiomyopathy: prevalence, determinants and potential treatments

Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial

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