[Reduction of cardiovascular morbidity and mortality by combined antihypertensive drug therapy in patients with type 2 diabetes mellitus].
The coexistence of diabetes mellitus in hypertensive patients doubles the number of cardiovascular events (relative risk: 1.73-2.77) and cardiovascular mortality (relative risk: 2.25-3.66). Therapeutic interventions concentrating on elevated blood glucose alone for prevention of late complications were not effective in essential reduction of cardiovascular morbidity and mortality. For that reason therapies, focussing on other macrovascular risk factors, did increase significantly in the last decade. Strategies for reduction of the macrovascular risk include the aggressive treatment of hypertension. In the now published hypertension intervention studies in diabetic patients many different objectives were studied. As we already know, lowering of blood pressure does reduce cardiovascular risk. The optimal blood pressure threshold is not known yet, but of major interest. To find the most effective antihypertensive agent and the most effective combination therapy for diabetic patients, the most frequently used antihypertensive agents were compared with each other. Very interesting are the special effects of some substances, which exceed the lowering of blood pressure, like effects on the endothelinn or on coagulation disturbances. These protective and antiatherosclerotic effects could possibly get relevance even in normotensive patients. Concerning this special question, ACE-inhibitors and Angiotensin II receptor antagonists are getting more and more in the focus of interest and seem to be superior compared to other substances. Concluding the existing evidence from hypertension studies the following recommendations can be deduced: Diabetic patients with at least one additional cardiovascular risk factor should get an ACE-inhibitor in combination with other antihypertensive agents or as monotherapy. For combination therapy all the available antihypertensive agents are appropriate and can lower blood pressure adequately.
Abrahamian
Heidemarie
H
3. Medizinische Abteilung, Krankenhaus der Stadt Wien-Lainz, Wolkersbergenstrasse 1, A-1130 Wien. dr.abrahamian@aon.at
Prager
R
R
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents