What question did this study set out to answer?

To assess the benefits of antihypertensive therapy in patients with both high blood pressure and diabetes mellitus.

September 11, 2000Archives of Internal Medicine133 citations

High Blood Pressure and Diabetes Mellitus

EGEhud Grossman FMFranz H. Messerli UGUri Goldbourt

Key Points

To assess the benefits of antihypertensive therapy in patients with both high blood pressure and diabetes mellitus.
Conducted a MEDLINE search for English-language articles on diabetes, hypertension, and therapy until June 1999.
Included prospective randomized studies lasting over 12 months that evaluated drug treatment effects on morbidity and mortality in diabetic hypertensive patients.
Analyzed the risk associated with diabetes and hypertension and their treatment outcomes.
Diabetes mellitus doubled the risk of cardiovascular events and cardiovascular mortality in hypertensive patients (RR 1.73-2.77 for events, 2.25-3.66 for mortality).
Intensive blood pressure control (<130/85 mm Hg) was beneficial in diabetic hypertensive patients.
Combination therapy was required in over 60% of patients to effectively control blood pressure.

Abstract

OBJECTIVE: To analyze the available data to assess the benefits of antihypertensive therapy in hypertensive patients with diabetes mellitus. METHODS: A MEDLINE search of English-language articles published until June 1999 was undertaken with the use of the terms diabetes mellitus, hypertension or blood pressure, and therapy. Pertinent articles cited in the identified reports were also reviewed. Included were only prospective randomized studies of more than 12 months' duration that evaluated the effect of drug treatment on morbidity and mortality in diabetic hypertensive patients. We estimated the risk associated with combination of diabetes mellitus and hypertension and the effect of treatment on morbidity and mortality. RESULTS: The coexistence of diabetes mellitus doubled the risk of cardiovascular events, cardiovascular mortality, and total mortality in hypertensive patients (approximate relative risk of 1.73-2.77 for cardiovascular events, 2.25-3.66 for cardiovascular mortality, and 1.73-2.18 for total mortality). Intensive blood pressure control to levels lower than 130/85 mm Hg was beneficial in diabetic hypertensive patients. All 4 drug classes-diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, and calcium antagonists-were effective in reducing cardiovascular events in diabetic hypertensive patients. In elderly diabetic patients with isolated systolic hypertension, calcium antagonists reduced the rate of cardiac end points by 63%, stroke by 73%, and total mortality by 55%. In more than 60% of diabetic hypertensive patients, combination therapy was required to control blood pressure. CONCLUSIONS: Intensive control of blood pressure reduced cardiovascular morbidity and mortality in diabetic patients regardless of whether low-dose diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, or calcium antagonists were used as a first-line treatment. A combination of more than 1 drug is frequently required to control blood pressure and may be more beneficial than monotherapy.

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