Treatment of hypertension in patients with type 2 diabetes: a review of the recent evidence

Chowdhury, TA; Kumar, Satyam; Barnett, A H; Dodson, P. M.

doi:10.1038/sj.jhh.1000920

Cited by 7 publications

(4 citation statements)

References 37 publications

(41 reference statements)

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“…CCBs are somewhat more efficacious for lowering BP than ACE inhibitors in some population groups, i.e., elderly, and in those who consume large amounts of sodium, i.e., more than 6 g/day 31 . While it is clear that use of short‐acting CCBs increase risk of cardiovascular events, 32 long‐acting CCBs have been shown to be safe and effective for reducing cardiovascular outcomes, especially strokes, in patients who have hypertension with or without diabetes 11,12,33,34 …”

Section: Discussionmentioning

confidence: 99%

“…There is increasing emphasis on integrating BP treatment into overall morbidity and mortality risk management strategies for patients with concomitant high BP and diabetes 9–11 . Apart from achieving BP control, the use of specific antihypertensive drugs— specifically, angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)—also reduces the risk for cardiovascular and renal disease in such patients 5,9 .…”

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confidence: 99%

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Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed‐Dose Combination Approaches

Bakris

Weir²

2003

J of Clinical Hypertension

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Data from the Third National Health and Nutrition Examination Survey (NHANES III) demonstrate that only 11% of people with diabetes who are treated for high blood pressure achieve the blood pressure goal of <130/85 mm Hg recommended in the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The current study tests the hypothesis that initial therapy with a fixed-dose combination will achieve the recommended blood pressure goal in patients with type 2 diabetes faster than conventional monotherapy. This randomized, double-blind, placebo-controlled study had as a primary end point achievement of blood pressure <130/85 mm Hg. Participants (N=214) with hypertension and type 2 diabetes received either amlodipine/benazepril 5/10 mg (combination) or enalapril 10 mg (conventional) once daily for 4 weeks, titrated to 5/20 mg/day or 20 mg/day, respectively at this time, if target blood pressure was not achieved. Hydrochlorothiazide (HCTZ) 12.5 mg/day was added for the final 4 weeks, if target blood pressure was still not reached. Time from baseline to achieve blood pressure <130/85 mm Hg was shorter in the combination group (5.3+/-3.1 weeks combination vs. 6.4+/-3.8 weeks conventional; p=0.001). At 3 months, more participants in the combination group achieved treatment goal (63% combination vs. 37% conventional; p=0.002). Data analysis at 3 months comparing blood pressure control rates between the fixed-dose combination group (without HCTZ) to the conventional group (receiving HCTZ) showed an even greater disparity in blood pressure goal achievement (87% combination without HCTZ vs. 37% conventional group with HCTZ; p=0.0001). We conclude that initial therapy with a fixed-dose combination may be more efficacious than conventional monotherapy approaches for achieving blood pressure goals in the diabetic patient. A fixed-dose combination approach appears as safe as the current conventional approaches.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed‐Dose Combination Approaches

Bakris

Weir²

2003

J of Clinical Hypertension

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“…Los BSRA han demostrado, al igual que los diuréticos y los beta-bloqueantes, que reducen la morbilidad y mortalidad cardiovascular 24,25 . Los IECA resultan beneficiosos en pacientes de alto riesgo, incluyendo diabetes mellitus, insuficiencia renal, disfunción sistólica ventricular izquierda, ateroesclerosis, edad avanzada e infarto de miocardio previo 26,27 . Los ARA-II se confirmaron como alternativa cuando los IECA no eran tolerados o en pacientes con nefropatía asociada a la diabetes tipo II 28,29 .…”

Section: Comparación Con La Literatura Científicaunclassified

Análisis del uso racional de antihipertensivos en la región de Murcia

et al. 2012

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The use of antihypertensive drugs in Murcia is less than in the rest of Spain. Therefore, this may be due to a problem of under treatment of this illness or other cardiovascular illnesses in the region. A greater use of ARB in Murcia and a lower use of ACEI was observed in Murcia. The differences found suggest that further studies are required to clarify their origins and causes, with the objective of achieving a more rational and efficient use of these drugs.

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“…However, those in the former group had the possibility of receiving an ACE inhibitor as well and more of them discontinued from the study, both of which would dilute any treatment differences [74]. Other analyses have been criticized for relying on subanalyses and secondary endpoints [75–82]. In particular, although the Antihypertensive Lipid‐Lowering Treatment to Prevent Heart Attack (ALLHAT) trial found a greater incidence of heart failure with an α 1 ‐blocker than a thiazide diuretic amongst the 36% of patients who had Type 2 diabetes, some could have been receiving diuretics at baseline, so providing symptomatic control of heart failure that ceased soon after switching to the α 1 ‐blocker [55].…”

Section: Components Of a Hypertension Management Strategymentioning

confidence: 99%

Hypertension in people with Type 2 diabetes: knowledge‐based diabetes‐specific guidelines

Members¹

2003

Diabetic Medicine

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The International Diabetes Federation (Europe) has updated these guidelines on hypertension management specifically in Type 2 diabetes in the light of recent results of the first prospective, randomized controlled studies to investigate clinical outcomes in people with diabetes and hypertension. The guidelines are knowledge based, i.e. based not only on evidence originating from clinical trials, but also from epidemiological and pathophysiological studies. A successful management strategy requires the following components: 1. Regular surveillance to detect developing hypertension and other cardiovascular (CV) risk factors. 2. Considering more frequent monitoring and review of CV risk factors if any single blood pressure (BP) measurement > 140/85 mmHg (or 130/75 if microalbuminuria); when appropriate, using ambulatory or home monitoring to establish the baseline BP. 3. Considering other CV risk factors, such as a raised albumin excretion rate, in setting the intervention threshold. 4. Individualizing the target BP in accordance with other CV risk factors. 5. Agreeing lifestyle and therapeutic interventions with the patient, with education and empowerment as required. 6. Implementing lifestyle modifications, including controlling calorie, salt and alcohol intake, increased physical activity, weight control and smoking cessation. 7. Therapeutic strategy: the primary goal of therapy is to reduce BP markedly. Combination therapy is often necessary, e.g. an angiotensin converting enzyme (ACE) inhibitor and a diuretic. Some classes are particularly useful for certain patients, notably longer-acting ACE inhibitors, angiotensin 2 receptor antagonists (A2RAs) and calcium antagonists in those at risk of diabetic nephropathy, loop diuretics and thiazides in those at risk of hyperkalaemia, beta-blockers and calcium antagonists (except short-acting dihydropyridines) in patients with angina, beta-blockers and ACE inhibitors after a myocardial infarction or in those with left ventricular dysfunction, and thiazide diuretics and long-acting dihydropyridine calcium antagonists for isolated systolic hypertension. A2RAs should be particularly considered when ACE inhibitors are not tolerated. alpha 1-Blockers should not be considered first line in the absence of outcome data. Cost of drugs will modify these strategies in developing countries. 8. Monitoring response to therapies and, if target levels are not achieved, either intensifying drug therapy if the CV risk justifies it, or reassessing the target. 9. Maintaining a quality assurance strategy. This strategy is summarized in a simple, practical management algorithm.

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Treatment of hypertension in patients with type 2 diabetes: a review of the recent evidence

Cited by 7 publications

References 37 publications

Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed‐Dose Combination Approaches

Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed‐Dose Combination Approaches

Análisis del uso racional de antihipertensivos en la región de Murcia

Hypertension in people with Type 2 diabetes: knowledge‐based diabetes‐specific guidelines

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