What is the optimal blood pressure in patients with diabetes mellitus?
Cardiovascular disease is the number one cause of death in patients with type 2 diabetes mellitus. This condition leads to an increased risk of premature mortality in patients with ischemic heart disease and stroke. Many risk factors besides hyperglycemia in itself contribute to this increased risk, acting in a synergistic fashion. One of the most important risk factors is hypertension. Several recent clinical trials have shown the benefits of reducing high blood pressure in patients with diabetes mellitus to lower levels than have previously been recommended in clinical guidelines. In both the United Kingdom Prospective Diabetes Study (UKPDS) and the Hypertension Optimal Treatment (HOT) study a significant trend for increased benefits associated with lower diastolic blood pressure levels was shown. Therefore, clinicians should be encouraged to do more to treat hypertension in patients with type 2 diabetes mellitus and increase the proportion of patients in whom acceptable blood pressure control is achieved. For example, in Sweden, acceptable blood pressure control is currently only achieved in about 20 to 25% of patients with type 2 diabetes mellitus. Recent evidence also points to the primary importance of a tight blood pressure control. This implies drug combination treatment for the majority of patients. Therefore, the clinician must be able to use a broad variety of antihypertensive drugs, and from these drugs choose alternative combinations with pharmacological synergism.
Nilsson
P
P
Department of Internal Medicine, University Hospital, Malmö, Sweden. Peter.Nilsson@medforsk.mas.lu.se
D000319:Adrenergic beta-Antagonists / Q000592:standards / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000592:standards / Q000627:therapeutic use; D001794:Blood Pressure; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D017410:Practice Guidelines as Topic / Q000592:standards
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors