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Antihypertensive Drugs In Diabetes

Diabetic Nephropathy And Antihypertensive Treatment: What Are The Lessons From Clinical Trials?:

Diabetic Nephropathy And Antihypertensive Treatment: What Are The Lessons From Clinical Trials?:

Diabetic nephropathy is the most serious problem among current issues in nephrology, as 40% of the cases of end-stage renal disease are due to this entity. The close relationship between type 2 diabetes and hypertension makes the problem even more severe. The knowledge of the intrarenal effects of angiotensin II and the greater effect of angiotensin converting enzyme inhibitors (ACEI) on reducing albuminuria suggested in the past a trend toward preferable use of these drugs in diabetic nephropathy. The first relevant clinical trials yielded rather poor conclusions because of lack of blind randomization and short duration. Subsequent double-blind studies with adequate numbers of patients and sufficient duration underlined the importance of blood pressure (BP) control as well as the rather poor response of diabetic nephropathy to any treatment. In most of these studies, the changes in albuminuria or microalbuminuria were a substitute end point for the renal function. Three clinical trials using angiotensin II receptor blockers (ARB), planned specifically to monitor the progression of renal damage, have been recently published. They showed better renal protection by ARB, as compared with placebo or calcium channel blockers (CCB), beyond or independently of the BP reduction. Nevertheless, these recent trials, like the previous ones with similar results, invariably demonstrate slightly better control of BP in the groups of the active drug. Another issue is that the vast majority of the patients need so many nonstudy drugs to keep their pressure under control, that the isolation of advantageous effects of certain drugs seems unrealistic. Diabetic nephropathy , albuminuria , clinical trials , antihypertensive treatment Diabetes mellitus (DM) is one of the strongest independen Continue reading >>

Choice Of Antihypertensive Drug In The Diabetic Patient.

Choice Of Antihypertensive Drug In The Diabetic Patient.

Choice of antihypertensive drug in the diabetic patient. The hypertensive patient with type 2 diabetes is especially at risk of adverse cardiovascular events. The United Kingdom Prospective Diabetes Study (UKPDS) and Hypertension Optimal Treatment (HOT) studies suggested that treatment to a lower target blood pressure resulted in better prevention of clinical disease in these patients. Most trials comparing antihypertensive drugs have shown only minimal differences between the various agents. The evidence from the trials suggests that diuretics, beta-blockers, calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibitors, and the angiotensin-receptor antagonists (ARBs) will all successfully reduce adverse clinical events. The largest of the comparative hypertensive drug trials, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), demonstrated that a diuretic has a better hypotensive effect, and was more successful in preventing many aspects of cardiovascular disease compared with CCBs and ACE inhibitors. The importance of good blood pressure control and the general equivalence of antihypertensive drugs were again shown in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial, which compared an ARB with a CCB. Choice of antihypertensive agent should be individualized and guided by the presence of concomitant clinical disease and the need to protect any specific target organ system in the diabetic hypertensive. Diuretics, being potent hypotensive drugs with clearly demonstrated clinical benefit, should form part of the antihypertensive regimen of most diabetic hypertensives. ACE inhibitors and ARBs are especially useful in preventing nephropathy. Most patients will require a combination of antihyperte Continue reading >>

Treatment Of Hypertension In Patients With Diabetes Mellitus

Treatment Of Hypertension In Patients With Diabetes Mellitus

INTRODUCTION AND PREVALENCE Hypertension is a common problem in patients with both type 1 and type 2 diabetes, but the time course in relation to the duration of diabetes is different [1-3]. Among those with type 1 diabetes, the incidence of hypertension rises from 5 percent at 10 years, to 33 percent at 20 years, and 70 percent at 40 years [1]. There is a close relation between the prevalence of hypertension and increasing albuminuria. The blood pressure typically begins to rise within the normal range at or within a few years after the onset of moderately increased albuminuria (the new term for what was previously called "microalbuminuria") [2] and increases progressively as the renal disease progresses. (See "Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus", section on 'Risk factors'.) These features were illustrated in a study of 981 patients who had type 1 diabetes for five or more years [3]. Hypertension was present in 19 percent of patients with normoalbuminuria, 30 percent with moderately increased albuminuria, and 65 percent with severely increased albuminuria (the new term for what was previously called "macroalbuminuria") [2]. The incidence of hypertension eventually reaches 75 to 85 percent in patients with progressive diabetic nephropathy [4]. The risk of hypertension is highest in blacks, who are also at much greater risk for renal failure due to diabetic nephropathy. (See "Overview of diabetic nephropathy".) The findings are different in patients with type 2 diabetes. In a series of over 3500 newly diagnosed patients, 39 percent were already hypertensive [5]. In approximately one-half of these patients, the elevation in blood pressure occurred before the onset of moderately increased albuminuria. Hypertension was strongly a Continue reading >>

Efficacy And Tolerability Of Antihypertensive Drugs In Diabetic And Nondiabetic Patients Aslam M, Ahmad M, Mobasher F - J Pharm Bioall Sci

Efficacy And Tolerability Of Antihypertensive Drugs In Diabetic And Nondiabetic Patients Aslam M, Ahmad M, Mobasher F - J Pharm Bioall Sci

Globally, hypertension and Type2 diabetes mellitus(Type2 DM) are established risk factor for mortality, morbidity, and are well-established public health problems due to cardiovascular, kidney complications as well as self-prescribing trends in underdeveloped countries. Owing to the increasing prevalence rate, hypertension is ranked third as a major disability causing global risk. [1] , [2] , [3] Hypertension and Type2 DM frequently exist concomitantly. [4] Etiology and disease mechanisms are common in both diseases, contributing to end-organ damage, particularly cardiovascular disease(CVD) and renal complications. [3] , [4] , [5] Epidemiological surveys reported that more than 90% of population living an average lifespan are at increased risk of developing hypertension because of sedentary behavior, obesity, and poor dietary habits. [6] Hypertension leads to 13.5% world's premature death, 6% disability, and about 50% glucose intolerance or hyperinsulinemia to reduce both macro-and micro-vascular complications, it is essential to achieve target blood pressure(BP). [7] , [8] It was demonstrated by clinical trials conducted with different groups of antihypertensive that control of systolic BP(SBP) to only 911mmHg and diastolic BP(DBP) to 29mmHg can reduce CVD events by 34%69% and microvascular complications by 26%46% within just 25years. [9] The prevalence of hypertension together with Type2 diabetes is increasing dramatically in Pakistani population. [9] Fortunately, risk of end-organ complications can be reduced by proper management of hypertension adopting nonpharmacological(lifestyle measures) as well as pharmacological measures. [10] Guidelines to manage hypertension are available nationally as well as internationally. [10] , [11] Seventh report of the Joint Nationa Continue reading >>

Antihypertensive Drugs Linked To Differential Risk For Diabetes

Antihypertensive Drugs Linked To Differential Risk For Diabetes

Home / Resources / Articles / Antihypertensive Drugs Linked to Differential Risk for Diabetes Antihypertensive Drugs Linked to Differential Risk for Diabetes AII receptor antagonists or ACE inhibitors are least associated with incident diabetes and the risk was highest with diuretics and beta-blockers. Hypertension treatment with angiotensin II receptor antagonists and ACE inhibitors is least likely to lead to diabetes; however, diuretics or beta-blockers increase a patients chance of developing diabetes. We should monitor our patients for the development of diabetes, and we should remain cognizant that different medicines have different propensities. But we should use all the medicines necessary to get and keep blood pressure under control, said William J. Elliott, MD, PhD, professor of preventive medicine, internal medicine and pharmacology at Rush Medical College of Rush University Medical Center, Chicago. Several long-term clinical trials have shown that patients on antihypertension medications are more likely to have reduced glucose tolerance and precipitated new-onset diabetes than those without hypertension. This is often attributed to increased weight, recent weight gain or stronger family history of diabetes among those with hypertension. Elliott and colleagues analyzed data to assess the relationship between long-term treatment with classes of antihypertensive drugs and incident diabetes. The researchers conducted a network meta-analysis of long-term, randomized clinical trials from 1966 to 2006 among 143,153 participants who did not have diabetes at randomization. They identified 22 clinical trials of each class of antihypertensive drugs. They assessed the chance that a person would develop diabetes during one to about five years of observation. Their findin Continue reading >>

Controlling Hypertension In Patients With Diabetes

Controlling Hypertension In Patients With Diabetes

Hypertension and diabetes mellitus are common diseases in the United States. Patients with diabetes have a much higher rate of hypertension than would be expected in the general population. Regardless of the antihypertensive agent used, a reduction in blood pressure helps to prevent diabetic complications. Barring contraindications, angiotensin-converting enzyme inhibitors are considered first-line therapy in patients with diabetes and hypertension because of their well-established renal protective effects. Calcium channel blockers, low-dose diuretics, beta blockers, and alpha blockers have also been studied in this group. Most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. Nearly one in four adults in the United States has hypertension, and more than 10 million adults have diabetes.1 Moreover, hypertension is twice as common in persons with diabetes as it is in others.2 Obesity may be a common link between the two disorders, but other factors such as insulin resistance3 and autonomic dysfunction4 may also be involved. Excess weight with truncal obesity, hypertension, impaired glucose tolerance, insulin resistance, and dyslipidemia are among the components of the metabolic syndrome, which has been associated with an increased risk of coronary heart disease.5 In general, only 25 percent of patients with hypertension have adequate control of their blood pressure.6 Blood pressure goals are lower, and thus more difficult to achieve, in patients who also have diabetes. Elevated blood pressure is known to contribute to diabetic microvascular and macrovascular complications (Table 1).4,7,8 Fortunately, reductions in blood pressure can decrease the risk of these complications.8 TABLE 1 Microvascular complications Renal d Continue reading >>

Antihypertensive Treatments For Adults With Type 2 Diabetes

Antihypertensive Treatments For Adults With Type 2 Diabetes

Antihypertensive treatments for adults with type 2 diabetes Antihypertensive treatments for adults with type 2 diabetes BMJ 2016; 352 doi: (Published 11 February 2016) Cite this as: BMJ 2016;352:i560 Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2G3 Patients with diabetes need better blood pressure control, not more debate about the relative merits of different drugs Clinically, pathophysiologically, and epidemiologically type 2 diabetes (hereafter, diabetes) and hypertension are tightly linked.1 About 50-60% of adults with diabetes have hypertension but only half with both conditions have adequate blood pressure control. Those with diabetes and hypertension are particularly susceptible to vascular injury because diabetes is associated with higher nocturnal pressures with greater 24 hour blood pressure load,2 impaired flow mediated autoregulation with associated microvascular injury, and stiffening of large arteries leading to increases in pulse pressure.1 Thus people with diabetes and hypertension are at an exponentially increased risk of death, myocardial infarction, heart failure, stroke, and end stage renal disease.2 How best to lower blood pressure in this population is an ongoing (and perhaps distracting) controversy that relates to whether or not diabetes is a compelling indication for using renin angiotensin system (RAS) blockers.3 The indications for RAS blockers are compellingheart failure, established coronary disease, chronic kidney disease with proteinuria. But should diabetes be on this list? Experts and Continue reading >>

(pdf) Prescribing Pattern Of Antihypertensive Drugs In Diabetic Patients Of Southern Province, Kingdom Of Saudi Arabia

(pdf) Prescribing Pattern Of Antihypertensive Drugs In Diabetic Patients Of Southern Province, Kingdom Of Saudi Arabia

Background. Hypertension is extremely prevalent in patients with diabetes. Limited data exist on utili- zation patterns of antihypertensive in this population are consistent with evidence-based practice guide- Objective. To evaluate utilization patterns of antihypertensive agents among diabetic patients with hy- Design. Retrospective descriptive cross sectional. Patients / Participants. 149 patients with diabetes and hypertension from outpatient department at Fam- ily Medicine Hospital, Ahadereda. Khamis Mushait, K.S.A. Results. Over 43% of patients were receiving calcium channel blockers (CCB), 36.2 % of received angio- tensin converting enzyme inhibitors (ACEI), followed by angiotensin receptor blockers (ARBs) (34.9%), diuretics (34.2%) and -blockers (16.2%). Patients on monotherapy were mostly receiving CCB (34.3%) and ACEI (29.9%). The majority (55.03%) of treated patients were on multidrug regimens. In patients with coronary artery disease (CAD), a diuretic with ACEI (25%) and calcium channel blocker with an- giotensin receptor blocker (25%) was most commonly prescribed. Conclusions. Patterns of antihypertensive therapy were generally consistent with international guide- lines. Areas of improvement include increasing ACEI/ARB and diuretic use, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population. Keywords: Hypertension, Diabetes, Antihypertensive agents. Antecedentes. La hipertensin es muy frecuente en los pacientes con diabetes. Existen datos limitados sobre los patrones de utilizacin de antihipertensivos en esta poblacin consistentes con las guas de Objetivo. Evaluar los patrones de utilizacin de antihipertensivos en los pacientes diabticos con hi- Diseo. Estudio retrospectivo descriptivo tr Continue reading >>

Antihypertensive Drugs As Predictors Of Type 2 Diabetes Among Subjects With Impaired Glucose Tolerance

Antihypertensive Drugs As Predictors Of Type 2 Diabetes Among Subjects With Impaired Glucose Tolerance

Volume 50, Issue 3 , December 2000, Pages 231-239 Antihypertensive drugs as predictors of Type 2 diabetes among subjects with impaired glucose tolerance Author links open overlay panel UllaRajalaa Get rights and content Aims: to examine the incidence rate of progression to Type 2 diabetes and baseline prognostic risk factors, focusing on hypertension and antihypertensive medication, in a cohort (n=207) with impaired glucose tolerance (IGT). Methods: after 2 and 4.6 (1.96.4) years new cases of diabetes were diagnosed by the oral glucose tolerance test (OGTT). Hypertension (BP 160/95 or antihypertensive medication) was included in multiple regression analyses to assess the effect of risk factors on the development of diabetes. Results: diabetes developed in 32 subjects (19%), an incidence of 41/1000 (95% CI 2857/1000) person-years. In univariate analyses, progression to diabetes was associated with a high (>9.0 mmol/l) 2-h OGTT value (P=0.008), a high fasting insulin (>12.0 mU/l) level (P=0.000), a high triglyceride (1.3 mmol/l) level (P=0.028), a high BMI (28.0 kg/m2) (P=0.013) and hypertension (P=0.003). The risk for the development of diabetes was not increased in hypertensive subjects without antihypertensive medication compared with normotensive subjects (OR 0.8, 95% CI 0.32.6). However, it was increased in subjects with on medication, especially diuretics alone or in combination with other drugs. Hypertensive subjects on diuretics had higher levels of fasting insulin and triglycerides and higher BMIs at baseline than normotensive subjects. After adjustment for 2-h OGTT, fasting insulin, triglycerides and BMI, the OR for diabetes was 7.7 (95% CI 2.128.2) in hypertensive subjects using diuretics alone or in combination with other drugs and 2.6 (95% CI 1.06.7) in thos Continue reading >>

Antihypertensive Drugs For Lowering Blood Pressure Could Up Risk Of Cardiovascular Death In Diabetes Patients

Antihypertensive Drugs For Lowering Blood Pressure Could Up Risk Of Cardiovascular Death In Diabetes Patients

Antihypertensive Drugs For Lowering Blood Pressure Could Up Risk Of Cardiovascular Death In Diabetes Patients Diabetes is a chronic disease in which blood glucose levels go unregulated, often rising to dangerously high levels. Unfortunately, its become more common in the United States, with more than 29 million people currently afflicted. If they dont already have it, many of them risk high blood pressure (hypertension) and cardiovascular disease . Doctors may recommend antihypertensive treatments to treat these conditions, but new research published in the British Medical Journal suggests this is a bad idea, as doing so might lead to adverse effects or even death. For their analysis, researchers at Ume University in Sweden collected data from 49 published and unpublished studies involving nearly 74,000 participants. Their goal was to investigate the effects of intensive blood pressure-lowering drugs on diabetes patients. Since we used only aggregated data from previous trials, we are unable to disseminate the results of the research to study participants directly, the researchers wrote. Nevertheless, their review yielded some surprising results. They found that the effects of antihypertensive medications depended on diabetic patients systolic blood pressure the top number on a persons blood pressure reading prior to treatment. Patients with a systolic blood pressure higher than 140 mm Hg before starting treatment experienced a lower risk of death, stroke, heart attack, and heart failure when they underwent intensive blood pressure treatment. These benefits didnt apply to those whose systolic blood pressure was under 140 mm Hg at the time treatment began; instead, antihypertensive medications increased their risk of cardiovascular death by 15 percent. Regardless, Matti Continue reading >>

Treating Hypertension In Diabetes: Data And Perspectives

Treating Hypertension In Diabetes: Data And Perspectives

Tightly controlling blood pressure has been shown to reduce cardiovascular risk and delay the development and progression of microvascular diabetic complications, including nephropathy and retinopathy. Several national expert consensus panels, including those of the American Diabetes Association and the current Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI), have recommended that the goal of blood pressure reduction should be <130/85 mm Hg. Results of a number of clinical studies demonstrate that blood pressure reduction in itself appears to be the most critical factor in preventing diabetic complications, rather than the specific agent(s) used. Aggressive goals are not likely to be achieved by monotherapy in most patients, as demonstrated in many studies, so combinations will be required to attain the best control with the fewest side effects. Controversy no longer exists regarding the beneficial effects of aggressive blood pressure control in individuals with diabetes. Tightly controlling blood pressure has been shown to effectively delay the development and progression of microvascular diabetic complications, including nephropathy and retinopathy. Moreover, extensive data from a number of studies have demonstrated that reduction of cardiovascular risk from such treatment is greater in the diabetic population than in the nondiabetic population. Much controversy, however, still rages surrounding the best approach for treatment, in part stemming from recent reports of increased cardiovascular events in diabetic populations treated with calcium channel blockers (CCBs), as well as from the lingering belief that diuretic treatment is associated with adverse effects in diabetic individuals. This article focuses Continue reading >>

1. Why Aceis Are Best Among Antihypertensive Drugs While There Is Diabetes Mellitus Concomitantly?

1. Why Aceis Are Best Among Antihypertensive Drugs While There Is Diabetes Mellitus Concomitantly?

Home Q & A Questions 1. Why ACEIs are best among... 1. Why ACEIs are best among Antihypertensive drugs while there is diabetes mellitus concomitantly? 2. Are osmotic diuretics used for the treatment of hypertension? 3. Oral hypoglycemic agents such as metformine and glibenclamide are administered best 4 More than 3 inhalations of salbutamole should not be required with in 24hr. why? 5 We dont undertake strenuous exercise while taking Norfloxacin. Why? 6 Is there an interaction between co-artem and If there is, is it harmful or useful interaction? 7 How does amitriptillin used for diabetic neuropaty? 8 What is the difference between omeprazole and cimetidin, omeprazole and antiacid, cimetidin and antiacid with respect to their clinical indication? I can help with a few of these-hopefully some of our pharmacists can chime in and will help more. If I remember right ACE inhibitors are used because they are more sparing of the kidneys than some of the others and protecting kidney function is vital in diabetics because diabetes in itself can destroy kidney function. Osmotic diuretics are not typically used for hypertension-they can actually aggravate HTN. Loop and thiazide diuretics are indicated for HTN. Oral hypoglycemics should be given before meals. Usually they are started out before breakfast or before dinner (with metformin), if that doesnt do it then a dose is added before evening meal (or morning meal if evening meal is started first). Very rarely have I seen them given TID or with the noon meal. Strenuous exercise and fluoroquinalones like Norfloxacin do not mix becuse of the possibility of tendon rupture is increased while taking fluorquinalones-any pain, inflammation or tendon issues should be reported and followed by the physician immediately until tendon ruptur Continue reading >>

Antihypertensive Drugs And Diabetic Retinopathy In Patients With Type 2 Diabetes

Antihypertensive Drugs And Diabetic Retinopathy In Patients With Type 2 Diabetes

Antihypertensive Drugs and Diabetic Retinopathy in Patients with Type 2 Diabetes I have read the Karger Terms and Conditions and agree. I have read the Karger Terms and Conditions and agree. Buy a Karger Article Bundle (KAB) and profit from a discount! If you would like to redeem your KAB credit, please log in . Save over 20% compared to the individual article price. Buy Cloud Access for unlimited viewing via different devices Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use * The final prices may differ from the prices shown due to specifics of VAT rules. For additional information: Objective: To evaluate the association between the development of sight-threatening diabetic retinopathy (STDR) and antihypertensive drugs (AHDs) use among type 2 diabetic patients with concomitant hypertension. Methods: Type 2 diabetic patients aged 20-100 years who had at least one prescription for AHDs between 2000 and 2011 were identified from the Longitudinal Health Insurance Database (LHID) 2005. The incidence rates of STDR were followed and Cox proportional hazard models were used to analyze the risk associated with AHDs. Results: Users of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were associated with a significantly higher risk than users of calcium channel blockers (CCBs), independent of baseline characteristics. After adjusting for time-varying use of concomitant medications for propensity score-matched or -unmatched cohorts, the results showed that patients receiving ACEIs/ARBs and CCBs were associated with a significantly greater risk compared with -blocker users. Conclusions: Our study did not Continue reading >>

Which Antihypertensive Drugs Are Best For Patients With Type 2 Diabetes And Hypertension?

Which Antihypertensive Drugs Are Best For Patients With Type 2 Diabetes And Hypertension?

This article requires a subscription for full access. NEJM Journal Watch articles published within the last six months are available to subscribers only. Articles published more than 6 months ago are available to registered users. Continue reading >>

Diabetes With Hypertension

Diabetes With Hypertension

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Home and Ambulatory Blood Pressure Recording article more useful, or one of our other health articles. This article aims to provide a simple management plan for the management of people with diabetes mellitus who also have raised blood pressure (BP). It is based mainly on the current National Institute for Health and Care Excellence (NICE) recommendations. Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality and are disproportionately affected by cardiovascular disease. Most of this excess risk is associated with high prevalence of well-established risk factors such as hypertension, dyslipidaemia and obesity in these patients.[1, 2]Hypertension plays a major role in the development and progression of microvascular and macrovascular disease in people with diabetes.[3] Early intervention and targeting multiple risk factors with both lifestyle and pharmacological strategies give the best chance of reducing macrovascular complications in the long term.[4] Antihypertensive therapies may promote the development of type 2 diabetes mellitus. Studies indicate that the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists (AIIRAs) leads to less new-onset diabetes compared to beta-blockers, diuretics and placebo.[5] Epidemiology Hypertension is more prevalent in patients with type 2 diabetes than in those who don't have diabetes.[4] It is estimated that the prevalence of arterial hypertension (BP greater than 160/95 mm Hg) in patients with type 2 diabetes is in the Continue reading >>

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