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April 1, 2003Annals of Internal Medicine

Treatment of Hypertension in Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice of Agents, and Setting Priorities in Diabetes Care

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Why the study?

What are the optimal blood pressure goals and preferred pharmacologic agents for treating hypertension in patients with type 2 diabetes mellitus?

Population

Patients with type 2 diabetes mellitus and hypertension

Comparison

Pharmacologic treatment of hypertension vs Placebo or other antihypertensive drug classes

Design

Systematic_review

Authors

SVSandeep VijanParkview Medical CenterRHRodney A. HaywardPreventive Cardiology

Discussion

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Implication

Supports intensive BP management with preferred agents in T2DM; reinforces Level 1 evidence for guideline-directed care.

Key Points

  • This paper evaluates the best blood pressure targets and treatment options for hypertension in patients with type 2 diabetes.
  • Review of randomized trials focusing on pharmacologic treatment of hypertension in diabetes.
  • Use of data sources like Cochrane Library and MEDLINE for literature review (updated 2002).
  • Standardized data extraction by reviewers to ensure accuracy.
  • Target diastolic blood pressure optimal at <80 mm Hg; systolic targets of 135 mm Hg are reasonable.
  • Preferred first-line agents include thiazide diuretics, angiotensin II receptor blockers, and ACE inhibitors.
  • Despite the effectiveness of various drug classes, aggressive blood pressure control is essential for preventing negative outcomes.

Structured PICO

What are the optimal blood pressure goals and preferred pharmacologic agents for treating hypertension in patients with type 2 diabetes mellitus?

P
Population
Patients with type 2 diabetes mellitus and hypertension
I
Intervention
Pharmacologic treatment of hypertension (including thiazide diuretics, angiotensin-II receptor blockers, ACE inhibitors, beta-blockers, and calcium-channel blockers)
C
Comparator
Placebo or other antihypertensive drug classes
O
Outcome
Microvascular and macrovascular outcomeshard clinical

Aggressive blood pressure control (target <135/80 mm Hg) using thiazide diuretics, ARBs, or ACE inhibitors as first-line agents is crucial for preventing adverse outcomes in patients with type 2 diabetes.

Cite This Study

Vijan et al. (2003) studied this question.

synapsesocial.com/papers/6a196589b71d9c859388fbb2https://doi.org/10.7326/0003-4819-138-7-200304010-00018

Topics

Hypertension management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Epidemiological Correlates of NIDDM in Hispanics, Whites, and Blacks in the u.s. Population1991 · 160 citations
  2. 2Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy2001 · 7,557 citations
  3. 3Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension1999 · 947 citations
  4. 4Use of Enalapril To Attenuate Decline in Renal Function in Normotensive, Normoalbuminuric Patients with Type 2 Diabetes Mellitus1998 · 389 citations
  5. 5Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)2002 · 5,708 citations