Aggressive treatment to lower blood
pressure in diabetics with clogged leg arteries significantly reduces the risk
of heart attacks and strokes, researchers say.
Diabetes and high
blood pressure are key risk factors for peripheral arterial disease (PAD), a
form of atherosclerosis that affects arteries leading to the legs and feet, say
the researchers from the University of Colorado Health Sciences Center.
PAD affects 8 million
to 12 million Americans, the American Heart Association says. Cholesterol-laden
plaque builds up in the blood vessels and reduces blood flow to the legs. That
limited blood flow can't meet the demand from legs when a person with PAD is
walking or exercising, and that shortfall results in pain, aching and fatigue in
the legs.
In a study published
in the Jan. 21 issue of Circulation, the researchers say clogging of leg
arteries, though often overlooked by primary-care doctors, can be a sign of
serious coronary disease.
Giving blood
pressure-lowering medications to those who have Type II, or adult-onset,
diabetes and peripheral arterial disease substantially reduced the risk of heart
attacks and strokes, the study says.
For five years, the
researchers followed 950 people with adult-onset diabetes, including 53 with
PAD.
Of the 53 patients
with PAD, 22 in an "intensive treatment" group received the blood-pressure
medications enalapril or nisoldipine, and 31 in a "moderate treatment" group
received placebos. Among those who received the medications, three, or about 14
percent, had strokes or heart attacks, compared with 12, or nearly 39 percent,
of those who did not take the medications.
"PAD is very common,
but it's under-recognized and under-treated," "It often presents itself as leg
cramping during exercise, and physicians don't tune in to it too much." says
Dr. William R. Hiatt, professor of medicine at the University of Colorado Health
Sciences Center.
Measuring blood
pressure in the ankle can provide a crucial early warning sign of coronary
disease -- and give physicians a chance to reduce the risk of heart attack or
stroke through intensive blood-pressure control, the study found.
"The point of this is
if you've got [PAD] in your leg, it is a sign of severe coronary disease, even
in the absence of a heart attack," Hiatt says. "What we're discovering is if you
treat those people aggressively, you can prevent heart attack and stroke."
Researchers also used
the "ankle-brachial index," which compares the blood flow in the arm and ankle
arteries of patients, to detect PAD.
Those in the moderate
treatment group with PAD had an increased risk of heart attack and stroke.
However, those in the intensive treatment group with PAD had no clinically
relevant increased risk of either.
Hiatt says the study
provides more evidence of the importance of aggressive blood-pressure control
for diabetics. He adds the type of blood pressure medication -- a
calcium-channel blocker or angiotensin-converting enzyme inhibitor -- did not
matter.
Dr. Michael Davidson,
director of preventive cardiology at Rush Heart Institute in Chicago, says the
study's findings underscore the need for aggressive treatment to lower blood
pressure in PAD patients.
"Before this study
came out, there was kind of an impression that we should do this, but now there
is more evidence that we should do this," Davidson says.
"The point is not just to treat the risk factors" for heart attack and stroke, he said, "but to treat them aggressively. Just treating them moderately may not be enough."
Source: Diabetes In Control.Com.
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