Hypertension in Type II Diabetes: Update on Therapy.
Cardiovascular disease (CVD) is the major cause of mortality in persons with type II diabetes mellitus and many factors contribute to its high prevalence; hypertension is one such factor. High blood pressure is about twice as frequent in persons with diabetes mellitus as those without the disease. Information from death certificates indicates that hypertension was implicated in 4.4% of deaths coded to diabetes, and diabetes was involved in 10% of deaths coded to hypertension related disease. Up to 75% of diabetes related cardiovascular complications may be attributable to hypertension. These observations have contributed to recommendations for more aggressive lowering of blood pressure (i.e., to less than 130/85 mm Hg) in persons with coexistent diabetes and hypertension. The goal of lowering blood pressure in persons with diabetes is to prevent hypertension associated death and disability. In older persons, the level of blood pressure and the diagnosis of hypertension should be based on multiple blood pressure measurements obtained in a standardized fashion on at least three occasions. Because of the propensity to orthostatic hypotension, standing blood pressures should be measured on patients on each office visit. Further, because of the increased blood pressure variability of these patients, ambulatory blood pressure measurements or home blood pressure monitoring may be valuable. The consensus blood pressure goal in diabetic persons with hypertension is less than 130/85 mm Hg. Pharmacologic therapy should be initiated when lifestyle modifications do not lower blood pressure to less than 130/85 mm Hg in diabetic persons. The National Institutes of Health Consensus Panel recommended four classes of drugs that are effective as first line, single agent therapy. Each drug class has potential advantages and disadvantages but combination therapy is usually necessary for adequate blood pressure control. (c)1999 by Le Jacq Communications, Inc.
Sowers
James R.
JR
Wayne State University School of Medicine and VA Medical Center, Detroit, MI.