Trends in hypertension management in Type I diabetes across Europe, 1989/1990 – 1997/1999

Abstract

Aims/hypothesis Our aim was to examine the change in the management of hypertension in patients with Type I (insulin-dependent) diabetes mellitus in Europe, between 1989Europe, between -1990Europe, between and 1997Europe, between -1999.Methods Seven-year changes in hypertension treatment and control (defined as blood pressure <130/85 mmHg) were examined in a large sample of Type I diabetic patients recruited from 26 centres involved in the EURODIAB Prospective Complications Study. Hypertension was defined as a systolic and/or diastolic blood pressure greater than 140 and/or 90 mmHg respectively, and/or use of blood pressure lowering drugs. 1Results Of 1866 Type I diabetic patients, 412 had hypertension at baseline and 631 at follow-up.A greater proportion of hypertensive patients were treated at follow-up (69% vs 40%, p<0.0001), which persisted after adjustment for age or centre. Of those who were treated, a modest increase in the proportion of those controlled for hypertension was found (41% vs 32%, p=0.048), which disappeared after adjustment for age. Among hypertensive patients with albuminuria, the proportions treated also increased, from 35% to 76% (p<0.0001) in microalbuminuric and 64% to 95% (p<0.0001) in macroalbuminuric patients. Control of hypertension in albuminuric patients did not change significantly and was below 50%. The use of more than one anti-hypertensive drug increased over a 7-year period, from 19% to 33% (p<0.0001), and a marked increase was shown in the proportion of those taking an ACE inhibitor (from 57% to 82%, p<0.0001). Conclusion/interpretationThe management of hypertension in Type I diabetic patients acrossEurope has improved over a 7-year follow-up period. Optimal levels of blood pressure treatment and optimal levels of control have not yet been achieved.Keywords Hypertension · Type I diabetes mellitus · albuminuria · control · blood pressure · treatment Abbreviations CCB Calcium channel blockerAn erratum to this article can be found at http://dx.doi.org/10.1007/s00125-003-1210-9In Type I (insulin-dependent) diabetes mellitus, raised blood pressure has been shown to be related to an increased risk of retinopathy [1,2,3], and cardiovascular disease [4,5] in several prospective studies independent of other risk factors. It is estimated that 30 to 75% of diabetic complications can be attributed to hypertension, which is twice as common in diabetic patients than in non-diabeticSeveral BP lowering trials have shown a reduction in microvascular and macrovascular complications in patients with Type II (non-insulin-dependent) diabetes mellitus [7,8]. Other recent trials have shown that, independent from BP lowering effects, the progression of diabetic nephropathy can be reduced by angiotensin II receptor blockers in Type II diabetic patients with hypertension and albuminuria [9,10,11]. In Type I diabetes, the progression of retinopathy [12]

Implementation of Guidelines for the Prevention of Diabetic Nephropathy

“…Nevertheless, adequate blood pressure control seems difficult to achieve in this group, where aggressive antihypertensive therapy is mandatory in preserving kidney function. Similar or slightly higher prevalences of controlled hypertension have been reported by others (14,15).…”

Levels of soluble receptor for AGE are cross-sectionally associated with cardiovascular disease in type 1 diabetes, and this association is partially mediated by endothelial and renal dysfunction and by low-grade inflammation: the EURODIAB Prospective Complications Study

“…These individuals were invited for a follow-up examination on average 7-9 years after the baseline examinations. Of the 3,250 included individuals, 1,880 (57.8%) returned for reexamination [26][27][28]. At follow-up, a cross-sectional nested case-control study of markers of inflammation and endothelial dysfunction and their associations with complications was performed in a subset of individuals (n=543) [22,23,[29][30][31][32][33].…”

Wytyczne ESC dotyczące cukrzycy, stanu przedcukrzycowego i chorób układu sercowo- -naczyniowego opracowane we współpracy z EASD

“…U chorych na cukrzycę typu 1 nadciśnienie tętnicze występuje częściej niż w populacji ogólnej (do 49% w badaniach DCCT/EDIC) [185,186]; stwierdza się je u ponad 60% chorych na cukrzycę typu 2 [187]. Według aktualnych teorii patofizjologicznych jest to spowodowane: 1) hiperinsulinemią związaną ze zwiększoną reabsorpcją sodu w nerkach; 2) zwiększonym napięciem układu współczulnego i 3) zwięk-szoną aktywnością układu renina-angiotensyna-aldosteron (RAAS) [188].…”