Antihypertensive therapy in diabetes mellitus: insights from ALLHAT and the Blood Pressure-Lowering Treatment Trialists’ Collaboration meta-analysis

Varughese, George; Lip, Gregory Y.H.

doi:10.1038/sj.jhh.1001926

Cited by 17 publications

(11 citation statements)

References 35 publications

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“…Diabetic patients are at risk of cardiovascular and atherosclerotic disease development and progression. Efforts should be made to reduce elevated blood pressure among diabetics with available medications, as tight blood pressure control have shown reductions in morbidity and mortality and diabetes related complications [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. Additionally, diabetic patients should be screened for dyslipidemia as well, as this pathological state leads to CAD or IHD with high morbidity and mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Association of Serum Lipids with High Blood Pressure and Hypertensionamong Diabetic Patients. Mathematical Regression Models to PredictBlood Pressure from Lipids. An Experience from 12-year Follow Up ofmore than 9000 Patients' Cohort

Aziz¹

2017

Gen Med

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Dyslipidemia and hypertension alone predispose to the risk of coronary artery disease, especially if the patient is diabetic. This risk is increased and multiplied when both dyslipidemia and hypertension coexists. There is a lack of studies and significant data for the correlation or association of blood pressure with serum lipids. The studies conducted in the past showed the conflicting results with poor associations. Furthermore, these studies were not conducted on diabetic subjects and lack regression models or mathematical linear equations. Hence, we conducted a prospective, observational cohort study on 9340 diabetic subjects for the duration of 12 year (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), with the aim to find significant associations, correlations between serum lipids (total cholesterol, triglycerides, LDL-C, HDL-C and Non-HDL-C) and blood pressure (systolic and diastolic). Our data has demonstrated that total cholesterol, triglycerides, and LDL-C were significantly correlated with systolic and diastolic BP, and raised among hypertensive patients as compared to non-hypertensive ( p<0.001 for all lipids). The highest correlations were found between Non-HDL-C with systolic and diastolic blood pressures (r=0.414 and r=0.415, respectively with p<0.001). However, HDL-C was inversely correlated with systolic and diastolic BP and was raised among non-hypertensive patients. Regression models and mathematical linear equations were developed to estimate increasing blood pressure by the given serum lipid levels. All regression models were significant (p<0.0001). We concluded and developed regression models, for the first time in medical research that high lipid levels contribute to the development of increase systolic and diastolic blood pressures. With triglycerides, total-cholesterol, and HDL-C, Non-DHL-C levels should also be calculated in diabetology clinics and general practice. Screening should be done for diabetic patients to detect high blood pressure (or HTN) and elevated serum lipids, and early initiation of management to prevent diabetes complications.

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Section: Discussionmentioning

confidence: 99%

Association of Serum Lipids with High Blood Pressure and Hypertensionamong Diabetic Patients. Mathematical Regression Models to PredictBlood Pressure from Lipids. An Experience from 12-year Follow Up ofmore than 9000 Patients' Cohort

Aziz¹

2017

Gen Med

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“…13,14 Of note, the importance of an elevated BP in subjects with DM is often underestimated and the number of antihypertensive drugs prescribed is insufficient. 24 Perhaps mandatory 'flagging' and/or reporting of uncontrolled hypertension in patients with DM, as is being currently piloted with HbA1c from early 2006 onwards for people with DM in New York, 25 may be one way forward.…”

Section: What Are the Possible Implications?mentioning

confidence: 99%

“…14,15 For example, in the United Kingdom Prospective Diabetes Study, a systolic and diastolic BP reduction by 10 and 5 mm Hg, respectively, had greater CVD risk reduction than lowering HbA1c by a mean of 0.9%. 16 This was further substantiated by the Hypertension Optimal Treatment (HOT) study, suggesting that there should perhaps be no lower threshold beyond which BP lowering is not considered to be beneficial in the setting of DM.…”

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confidence: 99%

Blood pressure control in the setting of diabetes mellitus: new targets, new hope for improvement?

2006

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The prevalence of hypertension in the setting of diabetes mellitus (DM) is high and the coexistence of the two conditions together is particularly unfavourable, as both the conditions are significant risk factors for vascular disease.1 The importance of optimal blood pressure (BP) and DM control is gaining further momentum lately, and the possibilities of additional improvements in the care of these patients are being explored worldwide.2,3 More recently, the question of whether enough attention was being given to BP measurements in DM clinics has been evaluated. 4 The results provide more insight into missed opportunities for aggressive BP management on a background of DM.Facing the diabetes epidemic and coexistent global burden of hypertension -what is the future going to be like?The national diabetes audit suggested that a quarter of people with DM in the UK remain undiagnosed. Hypertension, like DM is also becoming a major global health crisis, 2 demanding a vast proportion of health care resources directly and indirectly. The problem of hypertension in the setting of DM in the UK is large -a cross-sectional survey of over 250 000 patients from general practices across the UK recently reported that 56.2% of pharmacologically treated and 47.2% of diet-treated patients with DM had hypertension, as compared to 10.3% in those without DM.5 This was consistent with earlier reports, where the association between DM and hypertension was established in up to 65% of patients with DM, having major implications for cardiovascular disease (CVD) risk. 6,7 Interestingly, recent studies have shown that elevated systolic BP is present in almost all individuals with newly diagnosed DM. 8 One can only guess the future perspectives and magnitude of the situation given the global prevalence of DM and projections for 2030, 9 as well as the global challenge of hypertension over the next couple of decades.

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“…Furthermore, many 46 -48 but not all 49 recent studies with ACE inhibitors and ARBs suggest benefits that cannot be fully attributed to blood pressure lowering in preventing and delaying the progression of advanced diabetic kidney disease. 46,47 For these reasons, current guidelines 8 suggest that ACE inhibitors are the drugs of choice in the initial management of hypertension in people with diabetes or kidney disease.Regardless of the initial therapy, most patients will require multiple-drug therapy for hypertension in the setting of diabetes. Thiazide diuretics, ␤-blockers, ACE inhibitors, ARBs, and calcium channel blockers are beneficial in reducing CVD incidence in patients with diabetes.…”

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confidence: 99%

Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus

Buse¹,

et al. 2007

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Abstract-The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ. Key Words: AHA Scientific Statement Ⅲ cardiovascular diseases Ⅲ diabetes mellitus Ⅲ primary prevention D iabetes mellitus is a disease defined by abnormalities of fasting or postprandial glucose and frequently is associated with disorders of the eyes, kidneys, nerves, and circulatory system. Circulatory disorders associated with diabetes include coronary heart disease (CHD), stroke, peripheral arterial disease, cardiomyopathy, and congestive heart failure. Diabetes generally results in early death from cardiovascular diseases (CVDs). In 1999, the American Diabetes Association (ADA) and the American Heart Association (AHA) published a joint statement with the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney Diseases, and the Juvenile Diabetes Foundation International indicating the need for multiorganizational cooperation for prevention of CVD in patients with diabetes. 1 The present statement represents a joint response of the ADA and AHA to this challenge.The ADA and AHA each have published guidelines for CVD prevention that overlap with the present statement: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. The present document will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which ADA and AHA recommendations differ.Clear clinical trial evidence published over the past decade suggests that broad-based treatment of dyslipidemia, hypertension, and hypercoagulability (as well as interventional cardiology and cardiovascular surgery during the acute coronary syndrome 2 ) can improve the event-free survival rate in people with diabetes who already have clinical CVD. However, a much smaller body of clinical trial data addresses the issue of primary prevention of CVD in patients with diabetes and no known CVD. This is a critical issue because patients with diabetes have twice the risk of incident myocardial infarction and stroke as that of the general population. Furthermore, large numbers of people with diabetes do not survive their first event, and if they do survive, their mortalityThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the wr...

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Antihypertensive therapy in diabetes mellitus: insights from ALLHAT and the Blood Pressure-Lowering Treatment Trialists’ Collaboration meta-analysis

Cited by 17 publications

References 35 publications

Association of Serum Lipids with High Blood Pressure and Hypertensionamong Diabetic Patients. Mathematical Regression Models to PredictBlood Pressure from Lipids. An Experience from 12-year Follow Up ofmore than 9000 Patients' Cohort

Association of Serum Lipids with High Blood Pressure and Hypertensionamong Diabetic Patients. Mathematical Regression Models to PredictBlood Pressure from Lipids. An Experience from 12-year Follow Up ofmore than 9000 Patients' Cohort

Blood pressure control in the setting of diabetes mellitus: new targets, new hope for improvement?

Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus

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