Treating Hypertension in Patient with Type 2 Diabetes

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Treating Hypertension in the Patient with Type 2 Diabetes

Statement by Claude Lenfant, M.D., Director National Heart, Lung, and

Blood Institute

National Heart, Lung, and Blood Institute (NHLBI)

A new clinical advisory issued by the National High Blood Pressure

Education Program (NHBPEP) recommends that physicians pursue a more

aggressive treatment approach to lower the blood pressure of patients who

have both hypertension and diabetes.

The NHBPEP is coordinated by the National Heart, Lung, and Blood

Institute (NHLBI) of the National Institutes of Health. The " Clinical

Advisory Treatment of Hypertension and Diabetes, " is published in the

latest issue of The Journal of Clinical Hypertension.

Both diabetes and hypertension are independent risk factors for

cardiovascular disease (CVD). The advisory indicates that the coexistence

of these conditions in a patient imposes a need for a significantly lower

goal blood pressure (135/80 mm Hg) than the goal blood pressure

recommended for a patient with hypertension who does not have diabetes

(140/90 mm Hg). Over 5 million Americans have type 2 diabetes and high

blood pressure. Uncontrolled hypertension leads to stroke, heart failure,

and kidney failure. It is clear that the combination of these two CVD

risk factors has important public health implications.

This new report is part of a series of clinical advisories being issued

by NHLBI to raise health professional and consumer awareness of the

health dangers posed by high blood pressure. On May 4, 2000, NHLBI issued

a clinical advisory to draw attention to the problem of high systolic

blood pressure. Systolic blood pressure measures the force exerted by the

blood as it flows through the arteries when the heart contracts. It is

expressed as the top number of the blood pressure reading and now is

recognized to be the most important indicator of heart disease risk in

adults age 60 and older.

The authors of the new advisory note results from several studies showing

that efforts to lower high blood pressure in patients with type 2

diabetes produce dramatic results. In one study, near optimal control of

hypertension (144/82 mm Hg) led to 44 percent fewer diabetes-related

strokes, 37 percent fewer cases of small blood vessel damage due to

diabetes (particularly diabetic retinopathy), and 32 percent fewer

diabetes-related deaths. Another study reported CVD deaths were reduced

76 percent in hypertensive patients who had type 2 diabetes and 13

percent in patients who had hypertension but no diabetes.

The clinical advisory is an update to the Sixth Report of the Joint

National Committee on Prevention, Detection, and Treatment of High Blood

Pressure (JNC VI). JNC VI was produced in 1997 by the NHBPEP, a

federation of 45 professional, voluntary, and official agencies.

Marilyn

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Professional advice.