Prevalence and management of hypertension in Type 1 diabetes mellitus in Europe: the EURODIAB IDDM Complications Study

Collado-Mesa, Fernando; Colhoun, Helen M.; Stevens, L. K.; Boavida, J. M.; Ferriss, J. B.; Karamanos, B.; Kempler, Péter; Michel, Georges; Roglić, Gojka; Fuller, John; Group, the Eurodiab Iddm Complications Stu

doi:10.1046/j.1464-5491.1999.00007.x

Cited by 61 publications

(40 citation statements)

References 28 publications

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“…Thus, the proportion of patients considered to be hypertensive in our study was relatively high. This situation is probably caused by antihypertensive treatment for albuminuria in normotensive patients (especially ACE inhibitors), an issue also previously addressed by others (32,34). Successful blood pressure control with blood pressure Ͻ130/80 mmHg in both 1997 and 2004 was predicted by young age, female sex, short diabetes duration, low BMI in 1997, weight loss during the period, and absence of microalbuminuria in 1997.…”

Section: Conclusion -In This Surveymentioning

confidence: 84%

Glycemic and Risk Factor Control in Type 1 Diabetes

Eeg‐Olofsson

Cederholm²,

Nilsson³

et al. 2007

Diabetes Care

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OBJECTIVE -This study was designed to investigate the clinical characteristics of a large type 1 diabetic population and to evaluate the degree of fulfillment of recently updated treatment goals.RESEARCH DESIGN AND METHODS -The Swedish National Diabetes Register was initiated in 1996 as a tool for quality assurance in diabetes care. A1C levels, treatment, and risk factors were analyzed in two cross-sectional samples of 9,424 patients in 1997 and 13,612 patients in 2004 and in a smaller longitudinal sample from 1997 to 2004.RESULTS -Mean A1C decreased from 8.2 Ϯ 1.3% in 1997 to 8.0 Ϯ 1.2% in 2004 (P Ͻ 0.001). The proportion of patients reaching A1C Ͻ7.0% increased from 17.4 to 21.2% in 2004. A slow but significant improvement in blood pressure levels was seen, but only 61.3% reached the blood pressure goal of Ͻ130/80 mmHg in 2004. Lipid control improved, and the use of lipid-lowering drugs increased. Among patients treated with lipid-lowering agents, 38% reached the goal of total cholesterol Ͻ4.5 mmol/l, and 48% reached the goal of LDL cholesterol Ͻ2.5 mmol/l. Successful long-term glycemic and blood pressure control were both independently predicted by low BMI and the absence of microalbuminuria in 1997.CONCLUSIONS -In this large cohort of type 1 diabetic patients, there was a slow improvement in glycemic and risk factor control from 1997 to 2004, although the gap between the clinical results and current Swedish and American treatment goals is still unsatisfactory. It is crucial that additional measures be taken to improve risk factor control in type 1 diabetic patients. Diabetes Care 30:496 -502, 2007I t has long been established that good glycemic control of diabetes prevents microvascular complications (1,2), and epidemiological studies have demonstrated that glycemic control reduces the risk of macrovascular disease (3,4). In the recently updated American Diabetes Association (ADA) clinical practice recommendations (2006), the general glycemic goal is A1C Ͻ7.0% with an individual goal for A1C as close to normal as possible (Ͻ6%) (5). Clinical guidelines in Sweden since 1998 have recommended an A1C Ͻ7.3% (Diabetes Control and Complications Trial [DCCT] standardized A1C). The importance of treating hyperlipidemia (6), hypertension, and microalbuminuria (7) has clearly been shown, and, thus, strict risk factor control is recommended (5). The blood pressure goal has been set at Ͻ130/80 mmHg, and the goals for blood lipid levels have also recently been updated (total cholesterol Ͻ4.5 mmol/l, LDL cholesterol Ͻ2.5 mmol/l, HDL cholesterol Ն1.0 mmol/l in men and Ն1.3 mmol/l in women, and triglycerides Ͻ1.7 mmol/l) in ADA and European guidelines (5,8).The incidence of type 1 diabetes is high, Ն20/100,000 inhabitants per year, in Scandinavia (9,10). In 2004, 13,612 adult type 1 diabetic patients were reported to the Swedish National Diabetes Register (NDR). This cohort represents about 50% of the adult type 1 diabetic population in Sweden, and many of the subjects had been repeatedly reported to the NDR since 1996. The ...

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Section: Conclusion -In This Surveymentioning

confidence: 84%

Glycemic and Risk Factor Control in Type 1 Diabetes

Eeg‐Olofsson

Cederholm²,

Nilsson³

et al. 2007

Diabetes Care

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“…In 3,250 type 1 diabetic subjects seen in 1989 -1990 with a mean age of 32.7 years and duration of diabetes of 14.7 years, 24% had hypertension, of whom 48.5% were aware of the diagnosis and 42.2% were on treatment with only 11.3% controlled. Additionally, 81% of those on treatment were on only one antihypertensive medication (17). In the EURODIAB 7-year follow-up data, hypertension prevalence had increased from 412 to 631 subjects out of 1,866 subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Reports on prevalence, awareness, treatment, and control of hypertension exist for the general population (10,11) and the type 2 diabetic population (12)(13)(14)(15)(16), whereas data for patients with type 1 diabetes are limited, consisting of two EU-RODIAB reports (17,18) and one abstract from Pittsburgh (19). In the published reports on hypertension in type 1 diabetes, control groups are not included.…”

mentioning

confidence: 99%

Hypertension Prevalence, Awareness, Treatment, and Control in an Adult Type 1 Diabetes Population and a Comparable General Population

et al. 2005

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OBJECTIVE -To compare the prevalence, awareness, treatment, and control of hypertension in a population-representative sample of adults with type 1 diabetes and comparable nondiabetic control subjects. , the Coronary Artery Calcification in Type 1 Diabetes Study enrolled 1,416 individuals aged 19 -56 years with no known history of coronary artery disease: 652 type 1 diabetic patients (46% male, mean age 37 years) and 764 nondiabetic control subjects (50% male, mean age 39 years). Subjects were asked if they had been told by a physician that they had hypertension or were on a blood pressure medication. Blood pressure was measured using standardized Joint National Committee (JNC) protocol. RESEARCH DESIGN AND METHODSRESULTS -Type 1 diabetic subjects, compared with nondiabetic subjects, had higher rates of hypertension prevalence (43 vs. 15%, P Ͻ 0.001), awareness (53 vs. 45%, P ϭ 0.11), treatment (87 vs. 47%, P Ͻ 0.001), and control (55 vs. 32%, P Ͻ 0.001) for the JNC 6 goal (130/85 mmHg). Only 42% of all type 1 diabetic hypertensive subjects met the new JNC 7 goal (130/80 mmHg). Type 1 diabetic subjects had better blood pressure control (72 vs. 32%, P Ͻ 0.0001), using 140/90 mmHg as a common measure. The majority of treated subjects were on a single antihypertensive agent (75 vs. 64%).CONCLUSIONS -Subjects with type 1 diabetes have higher rates of hypertension prevalence, treatment, and control than nondiabetic subjects. However, hypertension remains largely uncontrolled, even if treated in high-risk populations, such as type 1 diabetic subjects and undiagnosed individuals in the general population. Achieving more stringent blood pressure goals will require increased attention and may necessitate the use of multiple antihypertensive agents. Diabetes Care 28:301-306, 2005N umerous advances in care have led to improved health and longer survival in patients with type 1 diabetes. Hypertension has been estimated to affect ϳ30% of type 1 diabetic patients and usually reflects the development of diabetic nephropathy (1). Effective control of blood pressure is a well-established target to decrease morbidity and mortality in patients with type 1 diabetes and nondiabetic individuals as well (1,2).In type 1 diabetes, hypertension is related to an increased risk of microvascular complications, such as retinopathy (3-5), and is a modifiable risk factor in the progression of nephropathy (6) as well as in the development of the macrovascular complications of cardiovascular disease (7,8). The risk of cardiovascular disease doubles with each increase of 20/10 mm/Hg beginning at 115/75 mm/Hg (2). It has been estimated that 35-75% of diabetes complications are due to hypertension (9). Recently revised guidelines have been published by both the American Diabetes Association (ADA) (1) and the Joint National Committee (JNC) 7 (2) regarding goals for blood pressure treatment.Reports on prevalence, awareness, treatment, and control of hypertension exist for the general population (10,11) and the type 2 diabetic population (12-16), wher...

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“…203 Another small study of T1DM showed 29% of patients had hypertension; the hypertension correlated with disease duration and severity, particularly nephropathy, 204 similar to findings from the EURODIAB Study. 205 A recent analysis of the predictors of major T1DM outcomes in the Pittsburgh EDC study showed that although glycemic control diminished in importance over time, hypertension continued to be a strong CVD predictor. 206 This may reflect the better glycemic control experienced by the later cohort, and perhaps the lack of amelioration of the profound adverse effects of hypertension on DM outcomes.…”

Section: Hypertensionmentioning

confidence: 99%