The choice of antihypertensive therapy in the diabetic patient

Struthers, Allan D.

doi:10.1136/pgmj.61.717.563

Cited by 25 publications

(6 citation statements)

References 53 publications

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“…In accordance with other studies carried out in hypertensive NIDDM patients, 46 -47 treatment with the ACE inhibitor during the present study did not adversely influence grycemic control and lipid profile. On the other hand, our results do not confirm previous observations 48 - 52 that treatment with diuretics in NEDDM patients worsens glycemic control or plasma lipid profile. However, the short duration of these studies may be the explanation, as most long-term studies showed no overall changes or short-term adverse effects that waned with time, occasionally to values below baseline.…”

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confidence: 99%

Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

et al. 1993

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The effects of long-term treatment with captopril and conventional therapy on albuminuria and metabolic parameters were compared in 74 hypertensive type II diabetics with normal serum creatinine. Patients were treated double-blind with either captopril monotherapy or combined with hydrochlorothiazide or therapy with metoprolol, hydrochlorothiazide, or both for 36 months. The treatment was titrated to achieve goal diastolic blood pressure of £85 mm Hg. The reductions in blood pressures during treatment were similar in patients with (n=21) and without (n=53) microalbuminuria treated with either captopril or conventional therapy. No significant changes in albuminuria occurred in normoalbuminuric patients with either therapy. Although albuminuria fell in nearly all patients with microalbuminuria treated with captopril, it rose in eight of 12 patients on conventional therapy, with macroalbuminuria developing in two of them. Renal function was preserved by both types of treatment in both patient groups. Long-term treatment with either conventional therapy or captopril did not alter metabolic variables. We conclude that captopril alone or in combination decreases albuminuria and prevents the development of macroalbuminuria in hypertensive type II diabetics with persistent microalbuminuria. The renoprotective effect of this agent, however, remains to be demonstrated with longer term data on renal function. Aggressive antihypertensive treatment with either captopril or conventional therapy appears to be effective in preventing the onset of microalbuminuria in most normoalbuminuric patients. In contrast, with previous short-term studies, the use of converting enzyme inhibitors or conventional therapy did not cause adverse metabolic effects. (Hypertension 1993^1:786-794) KEY WORDS • diabetes mellitus, non-insulin-dependent • captopril • antihypertensive agents • albuminuria R ecent cross-sectional studies have revealed a prevalence of microalbuminuria between 27% and 40% in patients with non-insulin-dependent diabetes mellitus (NIDDM) or type II diabetes attending diabetic clinics.

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Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

et al. 1993

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“…Blood-pressure lowering drugs that act directly on the renin-angiotensin system are therefore the treatments of choice for blood-pressure lowering in patients with the metabolic syndrome. In contrast, betablockers and thiazide diuretics may worsen glucose tolerance [35]. …”

Section: Prevention Of Diabetes In Patients With the Metabolic Syndromementioning

confidence: 99%

Prevention of Stroke in Patients with Diabetes mellitus and the Metabolic Syndrome

Rothwell

2005

Cerebrovasc Dis

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The basic principles of stroke prevention are the same in patients with diabetes and/or the metabolic syndrome as in those without. Blood-pressure lowering is highly effective in both primary and secondary prevention of stroke in diabetics, and there is no evidence to suggest that the benefits of lipid-lowering therapy are any less. Antiplatelet agents are effective in secondary prevention and may be indicated in asymptomatic diabetic patients, who have a substantially increased risk of acute vascular events. Uncertainty over optimal management of patients with diabetes, and possibly of those with metabolic syndrome, relates more to the thresholds for initiation of treatment. The decision to initiate treatment should depend on the balance between the absolute risk of potentially preventable events and the risks of any complications of treatment. The absolute risks of ischaemic stroke and acute coronary events are significantly increased in diabetics in population-based cohort studies and the recommended thresholds for instigating blood pressure lowering and lipid lowering are therefore lower than in the general population. Optimization of strategies to prevent vascular complications must be a priority, given the rapid rises in the incidence and prevalence of type 2 diabetes and the metabolic syndrome in most populations across the globe.

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“…However, the metabolic effects of those agents in diabetic and hypertensive patients are not well understood. Almost all studies on this subject have investigated the effects of calcium‐channel blockers on glycaemic control, plasma lipid levels and systemic blood pressure in patients with type 2 diabetes (Sruthers, 1985; Murad, 1991).…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that intracellular deposition of calcium increases in streptozotocin (STZ)‐induced diabetic models (Bhatnagar et al., 1984; Cruz, 1985). This situation has been explained with the action of hyperglycaemia which, through its inhibitory effect on Ca 2+ ATP‐ase, increases intracellular calcium concentrations (Bhatnagar et al., 1984; Sruthers, 1985). Increased intracellular calcium levels induce non‐enzymatic glycation, which leads to diabetic complications (Özden et al., 1989; Faure et al., 1993).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Metabolic and Antioxidant Effects of Diltiazem and Vitamin E on Streptozotocin‐diabetic Rats

Kaymaz

Telci

Albeniz

et al. 2004

Journal of Veterinary Medicine Series A

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In this study, solitary and combined effects of vitamin E and the calcium-channel blocker diltiazem were investigated in streptozotocin (STZ)-induced diabetic rats. Thirty male Wistar albino rats, weighing approximately 200 g were used. Diabetes mellitus was induced by a single intravenous injection of STZ at a dose of 65 mg/kg body weight. Five experimental groups were established as STZ-diabetic, STZ-diabetic + vitamin E, STZ-diabetic + diltiazem and STZ-diabetic + vitamin E + diltiazem. Vitamin E was injected intraperitoneally three times a week at a dose of 500 mg/kg body weight. Diltiazem was given orally every day at a dose of 25 mg/kg body weight. At the end of the study (10 weeks) blood glucose levels of diabetic rats, which had received vitamin E and diltiazem, had significantly decreased when compared with untreated diabetic rats (P < 0.02). Similarly, HbA1c levels had significantly decreased in diabetic rats which had received vitamin E (P < 0.05), diltiazem (P < 0.01) and vitamin E + diltiazem (P < 0.02) when compared with untreated diabetic rats. Liver glutathione levels of diabetic rats, which had received vitamin E (P < 0.01) and vitamin E + diltiazem (P < 0.05) had significantly increased when compared with untreated diabetic rats. Liver lipid peroxide levels had significantly decreased in diabetic rats, which had received vitamin E (P < 0.001) and diltiazem (P < 0.01). With respect to their metabolic and antioxidant effects, vitamin E proved superior to diltiazem.

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The choice of antihypertensive therapy in the diabetic patient

Cited by 25 publications

References 53 publications

Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

Prevention of Stroke in Patients with Diabetes mellitus and the Metabolic Syndrome

Comparison of the Metabolic and Antioxidant Effects of Diltiazem and Vitamin E on Streptozotocin‐diabetic Rats

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