Hypertension resistant to antihypertensive agents commonly occurs with the progression of diabetic nephropathy in Japanese patients with type 2 diabetes mellitus: a prospective observational study

Abstract

BackgroundWe investigated 1) the frequency of hypertension in patients with type 2 diabetes graded by the new classification of chronic kidney disease (CKD) reported by the Kidney Disease: Improving Global Outcomes (KDIGO) and 2) the number of antihypertensive agents needed to achieve treatment goals using a prospective observational study.MethodsA population of 2018 patients with type 2 diabetes mellitus was recruited for the study. The CKD stage was classified according to the eGFR and the urinary albumin excretion levels.ResultsHypertension was found in 1420 (70%) of the patients, and the proportion of subjects showing a blood pressure < 130/80 mmHg was 31% at the baseline. Although the mean blood pressure was approximately 130/75 mmHg, the rate of patients with a blood pressure of < 130/80 mmHg became limited to 41-50% during the observation period. The number of antihypertensive agents required for treatment was significantly higher at the endpoint (2.0 ± 1.3) than at the baseline (1.6 ± 1.2). Furthermore, it increased with the progression of the CKD stage at both the baseline and the endpoint of the observation. However, the frequency of subjects who did not achieve the blood pressure target was found to increase in the group demonstrating the later stage of CKD.ConclusionsHypertension resistant to antihypertensive agents was common in the patients with type 2 diabetes mellitus and increased with the progression of CKD. Although powerful combination therapy using antihypertensive agents is considered necessary for the strict control of blood pressure, this became difficult in individuals who were in advanced stages as graded based on the eGFR and the urinary albumin excretion levels.

The number of antihypertensive agents simply reflects the grade and the risk of atherosclerosis in patients with type 2 diabetes mellitus

“…Furthermore, it might be necessary to consider the vascular protective effects, as well as the blood pressure lowering effect when selecting antihypertensive agents for these patients. Approximately half of the patients required two or more antihypertensive agents in the present study, as previously reported [8,9]. The number of antihypertensive agents being used in our study was similar to that in a report investigating the status of blood pressure in 466 diabetic and 2934 nondiabetic Japanese patients with hypertension [21].…”

“…The risk for cardiovascular events synergistically increases in patients with both diabetes mellitus and hypertension [5]. Although the target blood pressure is recommended to be less than 130/80 mmHg in order to prevent diabetic vascular events [6,7], hypertension is often resistant to treatment in patients with type 2 diabetes mellitus [8,9]. It is difficult to control blood pressure using single agents, and combination therapy is needed in many diabetic patients with hypertension [9,10].…”

“…Although the target blood pressure is recommended to be less than 130/80 mmHg in order to prevent diabetic vascular events [6,7], hypertension is often resistant to treatment in patients with type 2 diabetes mellitus [8,9]. It is difficult to control blood pressure using single agents, and combination therapy is needed in many diabetic patients with hypertension [9,10]. When examining patients with hypertension resistant to antihypertensive agents, it is important to re-evaluate the various causes such as lifestyle, body weight, smoking habit and excessive alcohol consumption, in addition to re-considering the medication.…”

Resistant hypertension in patients with type 2 diabetes

“…CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate. Moreover, in a relatively small cohort of Japanese patients with type 2 diabetes, an increased frequency of hypertension requiring more drugs to be treated has been recently shown to be coupled with CKD progression [30]. ÃÃ P < 0.01.…”

The prevalence and assessment of chronic kidney disease with diabetes: single center study

“…There is significant difference in older and younger age in CKD with T2D and CKD without T2D. There is no significant difference between age group (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Systolic blood pressure was also higher in CKD patients with T2D than in those without T2D (P <0.001).…”