diabetestalk.net

Drug Of Choice For Hypertension In Diabetes

Diabetes And High Blood Pressure

Diabetes And High Blood Pressure

High blood pressure (hypertension) can lead to many complications of diabetes, including diabetic eye disease and kidney disease, or make them worse. Most people with diabetes will eventually have high blood pressure, along with other heart and circulation problems. Diabetes damages arteries and makes them targets for hardening, called atherosclerosis. That can cause high blood pressure, which if not treated, can lead to trouble including blood vessel damage, heart attack, and kidney failure. Compared to those with normal blood pressure readings, people with hypertension more often have: Peripheral vascular disease, hardening of the arteries in the legs and feet Even blood pressure that's at the higher end of normal (120/80 to 129/80), called elevated, impacts your health. Studies show that you have a two to three times greater chance of getting heart disease over 10 years. Readings vary, but most people with diabetes should have a blood pressure of no more than 130/80. The first, or top, number is the "systolic pressure," or the pressure in your arteries when your heart squeezes and fills the vessels with blood. The second, or bottom, number is the "diastolic pressure," or the pressure in your arteries when your heart rests between beats, filling itself with blood for the next contraction. When it comes to preventing diabetes complications, normal blood pressure is as important as good control of your blood sugar levels. Usually, high blood pressure has no symptoms. That's why you need to check your blood pressure regularly. Your doctor will probably measure it at every visit, and you may need to check it at home, too. Many of the things you do for your diabetes will also help with high blood pressure: Control your blood sugar. Don't drink a lot of alcohol. Limit how m Continue reading >>

Blood Pressure Control In Type 2 Diabetic Patients

Blood Pressure Control In Type 2 Diabetic Patients

Abstract Diabetes mellitus (DM) and essential hypertension are common conditions that are frequently present together. Both are considered risk factors for cardiovascular disease and microvascular complications and therefore treatment of both conditions is essential. Many papers were published on blood pressure (BP) targets in diabetic patients, including several works published in the last 2 years. As a result, guidelines differ in their recommendations on BP targets in diabetic patients. The method by which to control hypertension, whether pharmacological or non-pharmacological, is also a matter of debate and has been extensively studied in the literature. In recent years, new medications were introduced for the treatment of DM, some of which also affect BP and the clinician treating hypertensive and diabetic patients should be familiar with these medications and their effect on BP. In this manuscript, we discuss the evidence supporting different BP targets in diabetics and review the various guidelines on this topic. In addition, we discuss the various options available for the treatment of hypertension in diabetics and the recommendations for a specific treatment over the other. Finally we briefly discuss the new diabetic drug classes and their influence on BP. 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 >>

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 >>

Treatment Of Hypertension In Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice Of Agents, And Setting Priorities In Diabetes Care Free

Treatment Of Hypertension In Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice Of Agents, And Setting Priorities In Diabetes Care Free

Abstract Background: Hypertension in patients with type 2 diabetes mellitus is a prevalent condition that leads to substantial morbidity and mortality. Purpose: To evaluate the goals and optimal agents for treatment of hypertension in type 2 diabetes. Study Selection: Randomized trials that evaluated the pharmacologic treatment of hypertension in patients with diabetes and reported microvascular and macrovascular outcomes. Data Extraction: Studies were identified by using the Cochrane Library, MEDLINE, meta-analyses, review articles, and expert recommendation. The searches of the Cochrane Library and MEDLINE were performed in May 2000 and updated in April 2002. Data were abstracted to standardized forms by a single reviewer and were confirmed by a second reviewer. Data Synthesis: Treatment of hypertension in type 2 diabetes provides dramatic benefit. Target diastolic blood pressures of less than 80 mm Hg appear optimal; systolic targets have not been as rigorously evaluated, but targets of 135 mm Hg or less are reasonable. Studies that compare drug classes do not suggest obviously superior agents. However, it is reasonable to conclude that thiazide diuretics, angiotensin-II receptor blockers, and perhaps angiotensin-converting enzyme (ACE) inhibitors may be the preferred first-line agents for treatment of hypertension in diabetes. -Blockers and calcium-channel blockers are more effective than placebo, but they may not be as effective as diuretics, angiotensin-II receptor blockers, or ACE inhibitors; however, study results are inconsistent in this regard. Conclusions: Treatment of hypertension in type 2 diabetes, with blood pressure goals of 135/80 mm Hg, provides dramatic benefits. Thiazide diuretics, angiotensin II receptor blockers, and ACE inhibitors may be the best Continue reading >>

Treating High Blood Pressure And Diabetes

Treating High Blood Pressure And Diabetes

People with diabetes have an increased chance of developing high blood pressure, also known as hypertension. In fact, hypertension is twice as likely in people with diabetes as it is in people who don’t have diabetes. Almost 24 million people in the United States have diabetes — that’s about 8 percent of the entire population. And up to 60 percent of people with diabetes also have hypertension. Almost one-third of all those with high blood pressure and diabetes are unaware that they have hypertension, and 43 percent of those with diabetes who have high blood pressure go untreated. People with diabetes “are at higher risk for vascular disease, coronary artery disease, and cerebral vascular disease, which results in heart attacks and strokes," says Curtis Rimmerman, MD, staff cardiologist and echocardiographer at the Cleveland Clinic in Cleveland. "Oftentimes high blood pressure has a genetic component. Either way, controlling risk factors is important. There are [people with diabetes] who lead very healthy lifestyles and don't develop high blood pressure. But there's a tendency to be more overweight and more sedentary and have higher cholesterol levels, too." Gaining Control of Both Conditions It's very important to control hypertension because, like diabetes, it can lead to other health complications. If your blood travels through vessels with extra force due to hypertension, your heart must work harder and, as a result, your risks of cardiovascular diseases increase. The American Diabetes Association recommends aiming for blood pressure that's less than 130/80 mmHg (millimeters of mercury) if you have diabetes. “The lower the better," Dr. Rimmerman says. The Best Medicines for High Blood Pressure and Diabetes Having diabetes may also impact which hypertension Continue reading >>

Understanding And Treating Hypertension In Diabetic Populations

Understanding And Treating Hypertension In Diabetic Populations

Understanding and treating hypertension in diabetic populations Understanding and treating hypertension in diabetic populations Understanding and treating hypertension in diabetic populations Massimo Volpe1,2, Allegra Battistoni1, Carmine Savoia1, Giuliano Tocci1,2 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, SantAndrea Hospital, Rome, Correspondence to: Prof. Massimo Volpe, MD, FAHA, FESC. Chair and Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, SantAndrea Hospital, Via di Grottarossa 1035-9, 00189 Rome, Italy. Email: Abstract: Hypertension and diabetes frequently occurs in the same individuals in clinical practice. Moreover, the presence of hypertension does increase the risk of new-onset diabetes, as well as diabetes does promote development of hypertension. Whatever the case, the concomitant presence of these conditions confers a high risk of major cardiovascular complications and promotes the use integrated pharmacological interventions, aimed at achieving the recommended therapeutic targets. While the benefits of lowering abnormal fasting glucose levels in patients with hypertension and diabetes have been consistently demonstrated, the blood pressure (BP) targets to be achieved to get a benefit in patients with diabetes have been recently reconsidered. In the past, randomized clinical trials have, indeed, demonstrated that lowering BP levels to less than 140/90 mmHg was associated to a substantial reduction of the risk of developing macrovascular and microvascular complications in hypertensive patients with diabetes. In addition, epidemiological and clinical reports suggested that the low Continue reading >>

What Should Be The Antihypertensive Drug Of Choice In Diabetic Patients And Should We Avoid Drugs That Increase Glucose Levels? Pro And Cons.

What Should Be The Antihypertensive Drug Of Choice In Diabetic Patients And Should We Avoid Drugs That Increase Glucose Levels? Pro And Cons.

What should be the antihypertensive drug of choice in diabetic patients and should we avoid drugs that increase glucose levels? Pro and Cons. Munich Diabetes Research Group e.V., Munich Helmholtz Centre, Ingolstaedter Landstrasse 1, Munich-Neuherberg, Germany. [email protected] Diabetes Metab Res Rev. 2012 Dec;28 Suppl 2:60-6. doi: 10.1002/dmrr.2355. It has long been known that antihypertensive drugs may affect blood glucose in a differential manner. In particular new onset diabetes is significantly increased in association with the use of thiazides or beta-blockers, respectively, compared to placebo, whereas treatment with angiotensin-conversion-enzyme-inhibitors or angiotensin-receptor-blockers is associated with a lower than expected frequency, as also assessed in several meta-analyses. In line with these notions, the NAVIGATOR Trial was the first to report a significant preventive effect of an angiotensin-receptor-blocker on new onset diabetes evaluated as a primary outcome in a prospective randomized study. Hence, and in view of the fact that comparable blood pressure lowering with any of the five major classes of antihypertensive drugs, including calcium-channel-blockers, give comparable benefits in reducing cardiovascular complications, unless there are specific indications or contraindications for an individual drug, caution should be exercised, therefore, to use beta-blockers or thiazides as first-line drugs for blood pressure lowering indications in subjects at high risk to develop diabetes, especially in patients with so called metabolic syndrome. The potential of glycemic worsening in overt diabetic patients with thiazides or beta-blockers has less well been studied systematically, yet paradigmatically in UKPDS evaluating a randomized comp 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 >>

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 >>

Diabetic Kidney Disease: Hypertension Management

Diabetic Kidney Disease: Hypertension Management

Diabetic Kidney Disease: Hypertension Management Diabetic Kidney Disease: Hypertension Management Does this patient have diabetes-related hypertension? Presentation of hypertension in diabetic nephropathy A 58-year-old man presents with elevated blood pressure (BP) confirmed on two occasions by his primary care physician. At his first visit, his BP was 162/88 mmHg, and he was advised to lose weight, exercise, and limit sodium consumption. He currently feels well. His past medical history includes type 2 diabetes mellitus for 8 years, dyslipidemia treated with glyburide 5 mg daily, and atorvastatin 20 mg. On physical exam: BP 158/92 mm Hg, pulse 68 beats/min and regular, and a body mass index of 33. Jugular venous distension is not visible. Cardiac auscultation reveals a clear S1 and S2, and no S3 or S4. Lungs are clear to auscultation and there is trace peripheral edema at his ankles. Laboratory testing performed 4 months earlier revealed a serum creatinine of 1.6 mg/dl, estimated glomerular filtration rate (eGFR) 44 ml/min/1.73m2, potassium 3.6 mEq/l, HDL 31 mg/dl, LDL 120 mg/dl, glucose 210 mg/dl, and urinary albumin-creatinine ratio 450 mg/g. The remainder of his work-up for anemia and mineral and bone disorder is unremarkable. This patient has chronic kidney disease (CKD) Stage 3b nephropathy with severely increased proteinuria, as well as low serum potassium. These need to be confirmed, so a repeat chemistry panel for electrolytes and blood urea nitrogen/creatinine (BUN/Cr) should be performed. In addition, a repeat lipid profile and urine albumin:creatinine ratio should be obtained to assess changes that may have occurred over the preceding months. Doppler renal ultrasound should also be performed to evaluate kidney size and renal artery blood flow Given this his 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 >>

Common Blood Pressure Drug May Prevent Type 1 Diabetes

Common Blood Pressure Drug May Prevent Type 1 Diabetes

Common blood pressure drug may prevent type 1 diabetes Researchers from Colorado and Florida have found that a drug commonly used to control blood pressure could have another use: preventing and treating type 1 diabetes. Researchers have identified a blood pressure drug that could help to prevent type 1 diabetes. The new research co-authored by Dr. Aaron Michels, an associate professor of medicine at the University of Colorado Anschutz Medical Campus in Aurora will be published in The Journal of Clinical Investigation. Type 1 diabetes is a condition in which the beta cells of the pancreas are unable to produce enough insulin , which is the hormone that regulates blood sugar levels. This is believed to be down to an autoimmune process, wherein the immune cells mistakingly attack and destroy beta cells. Around 5 percent of all diabetes cases are type 1. It is most commonly diagnosed during childhood, adolescence, or young adulthood, but it can develop at any age. While the exact causes of type 1 diabetes remain a mystery, Dr. Michels and team note that around 60 percent of those who are at risk of the condition possess a molecule called DQ8 which previous research has linked to the onset of type 1 diabetes. With this in mind, the researchers speculate that blocking the DQ8 molecule could be one way of preventing type 1 diabetes. In their latest study, they identified an existing drug that could do just that. The researchers came to their findings by using a "supercomputer" to analyze every small molecule drug that had been approved by the Food and Drug Administration (FDA). Specifically, they investigated whether any of these medications could target and inhibit the DQ8 molecule. They found one that hit the mark: a drug called methyldopa , which is most often prescribed 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 >>

Management Of Blood Pressure In Patients With Diabetes

Management Of Blood Pressure In Patients With Diabetes

Management of Blood Pressure in Patients With Diabetes Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, affiliated to Sackler Faculty of Medicine, Tel-Aviv University Division of Cardiology, Luke's-Roosevelt Hospital and Columbia University American Journal of Hypertension, Volume 24, Issue 8, 1 August 2011, Pages 863875, Ehud Grossman, Franz H. Messerli; Management of Blood Pressure in Patients With Diabetes, American Journal of Hypertension, Volume 24, Issue 8, 1 August 2011, Pages 863875, Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality in patients with diabetes. Lowering blood pressure (BP) to 135/85 mmHg is the main goal of treatment. A nonpharmcologic approach is recommended in all patients. If BP levels remain above the target despite nonpharmacologic treatment, drug therapy should be initiated. Blockers of the reninangiotensinaldosterone system (RAAS) represent the cornerstone of the antihypertensive drug arsenal; however, in most patients, combination therapy is required. For many patients, a combination of RAAS blocker and calcium antagonist is the combination preferred by the treating physician. Often three or even four drugs are needed. Treatment should be individualized according to concomitant risk factors and diseases and depending on the age and hemodynamic and laboratory parameters of the patient. In order to maximally reduce cardio renal risk, control of lipid and glycemic levels should also be ensured. American Journal of Hypertension, advance online publication 28 April 2011; doi:10.1038/ajh.2011.77 blood pressure , diabetes mellitus , hypertension , treatment Hypertension is a powerful risk factor for cardiovascular morbidity and mortality, 1 particuarly Continue reading >>

More in diabetes