Randomised trial of effects of calcium antagonists compared with diuretics and β-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study

Hansson, Lennart; Hedner, Thomas; Lund‐Johansen, Per; Kjeldsen, Sverre E.; Lindholm, Lars; Syvertsen, Jan Otto; Lanke, Jan; Fairé, Ulf dé; Dahlöf, Björn; Karlberg, Bengt E.

doi:10.1016/s0140-6736(00)02526-5

Cited by 824 publications

(496 citation statements)

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“…As far as the use of CCB is concerned, some trials have demonstrated that the effects of this class of drugs are similar to those observed with CT (51,53,54). Since it was believed that CCB are responsible for a greater percentage of cardiovascular events, these findings could allow us to rule out this hypothesis with regards to hypertensive patients with type 2 diabetes.…”

Section: Cardiovascular Protectionmentioning

confidence: 90%

Optimizing Therapy in the Diabetic Patient with Renal Disease

Ravera¹,

Berruti²,

Leoncini³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Hypertension, impaired renal function, and proteinuria are commonly associated to the presence of diabetes. They play a major role in the development of cardiovascular and renal damage. Effective antihypertensive treatment reduces the progression of diabetic nephropathy and improves cardiovascular prognosis. Accordingly, tight BP control (Ͻ130/80 mmHg) is currently recommended in diabetic patients. Achieving BP targets represents the most important determinant of cardiovascular and renal protection. However, it has been suggested that specific classes of antihypertensive drugs may exert additional organ protection beyond their BP control. The pharmacologic blockade of the renin-angiotensin-aldosterone system has been shown to convey greater renal and cardiovascular protection compared with other classes of drugs. In particular, studies focusing on renal end point suggest that angiotensin-converting enzyme inhibitors (ACEI) are the firstchoice drugs in type 1 diabetes. Both ACEI and angiotensin II receptor blockers prevent the progression from microalbuminuria to clinical proteinuria in type 2 diabetes, but angiotensin blockers provide better renoprotection in patients with overt nephropathy. Regarding cardiovascular protection, several studies (but not all) have shown that ACEI exert a protective effect on diabetic patients. Recently, interesting results in favor of angiotensin receptor blockers have been reported in the IDNT, RENAAL, and LIFE studies. It should be noted that to achieve maximal renal and cardiovascular protection, most diabetic patients require integrated therapeutic intervention, including not only several antihypertensive drugs, but statins and antiplatelet therapy as well.Diabetes, hypertension, impaired renal function, and proteinuria are commonly associated conditions that act as a guilty company. They are, in fact, responsible for an increase in the risk of development and/or progression of cardiovascular disease, nephropathy, and retinopathy.Arterial BP plays a very important role in the development of renal damage and presents a complex relationship with diabetic nephropathy, with nephropathy raising BP, and with BP accelerating the course of nephropathy (1). Furthermore, as shown by epidemiologic studies, hypertension is responsible for increased cardiovascular morbidity and mortality associated with diabetes mellitus (1). Effective antihypertensive treatment reduces the risk of development and progression of nephropathy and, as is especially evident with angiotensinconverting enzyme (ACE) inhibitors (ACEI) and angiotensin receptor blockers (ARB), it lowers cardiovascular morbidity and mortality (2,3). Accordingly, current consensus groups have recommended tight BP control (Ͻ130/80 mmHg) in diabetic patients (2,4 -7).Proteinuria is considered a predictor of renal disease progression. Proteinuria acts on tubular cells by inducing inflammation and consequently interstitial fibrosis. In addition, proteinuria favors dyslipidemia, which aggravates renal damage and increases cardiov...

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Section: Cardiovascular Protectionmentioning

confidence: 90%

Optimizing Therapy in the Diabetic Patient with Renal Disease

Ravera¹,

Berruti²,

Leoncini³

et al. 2004

Journal of the American Society of Nephrology

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“…Lower target levels (<130/80 mmHg) were indicated [29,30,31] and greater risk reductions were reported in diabetic patients than in non-diabetic subjects [32,33] Different anti-hypertensive treatments have been examined, including ACE inhibitors [31,34,35,36], diuretics or beta-blockers [32,36,37,38] and CCB's [33,35,36,37,38] which all have been shown to be beneficial compared to placebo or conventional treatments. To achieve lower BP goals in diabetic patients with hypertension, the use of ACE inhibitors (or angiotensin II receptor blockers if ACE inhibitors cannot be tolerated) as first-line therapy and the use of multiple agents has been shown to be advantageous [29,30].…”

Section: Clinical Trials With Bp Lowering Drugs Convincing Evidence mentioning

confidence: 99%

Trends in hypertension management in Type I diabetes across Europe, 1989/1990 – 1997/1999

et al. 2002

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Aims/hypothesis Our aim was to examine the change in the management of hypertension in patients with Type I (insulin-dependent) diabetes mellitus in Europe, between 1989Europe, between -1990Europe, between and 1997Europe, between -1999.Methods Seven-year changes in hypertension treatment and control (defined as blood pressure <130/85 mmHg) were examined in a large sample of Type I diabetic patients recruited from 26 centres involved in the EURODIAB Prospective Complications Study. Hypertension was defined as a systolic and/or diastolic blood pressure greater than 140 and/or 90 mmHg respectively, and/or use of blood pressure lowering drugs. 1Results Of 1866 Type I diabetic patients, 412 had hypertension at baseline and 631 at follow-up.A greater proportion of hypertensive patients were treated at follow-up (69% vs 40%, p<0.0001), which persisted after adjustment for age or centre. Of those who were treated, a modest increase in the proportion of those controlled for hypertension was found (41% vs 32%, p=0.048), which disappeared after adjustment for age. Among hypertensive patients with albuminuria, the proportions treated also increased, from 35% to 76% (p<0.0001) in microalbuminuric and 64% to 95% (p<0.0001) in macroalbuminuric patients. Control of hypertension in albuminuric patients did not change significantly and was below 50%. The use of more than one anti-hypertensive drug increased over a 7-year period, from 19% to 33% (p<0.0001), and a marked increase was shown in the proportion of those taking an ACE inhibitor (from 57% to 82%, p<0.0001). Conclusion/interpretationThe management of hypertension in Type I diabetic patients acrossEurope has improved over a 7-year follow-up period. Optimal levels of blood pressure treatment and optimal levels of control have not yet been achieved.Keywords Hypertension · Type I diabetes mellitus · albuminuria · control · blood pressure · treatment Abbreviations CCB Calcium channel blockerAn erratum to this article can be found at http://dx.doi.org/10.1007/s00125-003-1210-9In Type I (insulin-dependent) diabetes mellitus, raised blood pressure has been shown to be related to an increased risk of retinopathy [1,2,3], and cardiovascular disease [4,5] in several prospective studies independent of other risk factors. It is estimated that 30 to 75% of diabetic complications can be attributed to hypertension, which is twice as common in diabetic patients than in non-diabeticSeveral BP lowering trials have shown a reduction in microvascular and macrovascular complications in patients with Type II (non-insulin-dependent) diabetes mellitus [7,8]. Other recent trials have shown that, independent from BP lowering effects, the progression of diabetic nephropathy can be reduced by angiotensin II receptor blockers in Type II diabetic patients with hypertension and albuminuria [9,10,11]. In Type I diabetes, the progression of retinopathy [12]

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“…9,10 Similarly, while the Hypertension Optimal Treatment (HOT) trial underlined the role of long acting CCBs in the treatment of hypertension, Syst-Eur and Nordic Diltiazem (NORDIL) study highlighted their efficacy in the elderly. 11,12 Historically, beta-blockers have been one of the most widely used drug classes for use in treating hypertension. Our survey demonstrates a clear move away from these as first-line therapy in the management of hypertension.…”

Section: Scenariomentioning

confidence: 99%