Aggressive blood pressure control
may be the most important factor in preventing adverse outcomes in patients with
type 2 diabetes.
Because hypertension,
a common problem in patients with type 2 diabetes, is associated with
substantial morbidity and mortality, aggressive treatment should be a priority,
according to guidelines to be released Tuesday by the American College of
Physicians (ACP).
Specifically,
clinicians treating such patients should aim for blood pressures no greater than
135/80 mm Hg, the guidelines indicate. Achieving this target "provides dramatic
benefits," according to the findings published in the April 1st issue of the
Annals of Internal Medicine.
"Most of the focus in
diabetes care has been on tight control of blood sugar," lead author Dr.
Vincenza Snow, a senior medical associate of scientific policy at ACP, said in a
statement. "We want both doctors and patients to know that aggressive blood
pressure control is also important in managing diabetes."
The guidelines
recommend that thiazide diuretics or ACE inhibitors be used as first-line
therapy. In general, these drugs are comparable, according to the guidelines,
but diuretics are the preferred agents for black patients due to a beneficial
effect on stroke and heart failure rates.
While these drugs may
represent the best initial therapy, the guidelines emphasize that it is not
uncommon for two or more agents to be needed to achieve target blood pressures.
The guidelines are
based on a review of randomized trials conducted by Dr. Sandeep Vijan and Dr.
Rodney A. Hayward, from the University of Michigan in Ann Arbor. Eight trials
compared blood pressure control versus placebo or assessed blood pressure
targets, and 10 trials compared the efficacy of different antihypertensive drug
classes.
There is strong
evidence that 80 mm Hg is the optimal limit for diastolic blood pressure, Dr.
Vijan and Dr. Hayward note. Although the target for systolic pressure has not
been as rigorously studied, it appears that maintaining a pressure of 135 mm Hg
or less is a reasonable goal.
"Aggressive blood pressure control may be the most important factor in preventing adverse outcomes in patients with type 2 diabetes," Dr. Vijan and Dr. Hayward conclude.
Source: Diabetes In Control Dot Com: Ann Intern Med 2003;138:587-602.
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