TY - JOUR
T1 - Controversies surrounding the treatment of the hypertensive patient with Diabetes
AU - Prisant, L. Michael
AU - Louard, Rita J.
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 1999
Y1 - 1999
N2 - Diabetes mellitus without previous myocardial infarction carries the same risk of a future myocardial infarction as someone who has had one. Intense glucose, lipid, and blood pressure control in diabeti patients is advocated to reduce cardiovascular events and decrease the incidence of end-stage renal disease, retinal damage, and peripheral vascular disease. Recent studies, including the Systolic Hypertension in the Elderly Program, indicate that low-dose diuretics, compared with placebo, reduce fatal and nonfatal myocardial infarctions but not fatal and nonfatal stroke in diabetic patients. Similarly, captopril (and diuretics) compared with diuretics and β-blockers decreased fatal and nonfatal myocardial infarctions but not fatal and nonfatal strokes in the Captopril Prevention Project. Intense blood pressure therapy with captopril and intense blood pressure therapy with atenolol equally lowered macrovascular and microvascular events compared with less intense blood pressure treatment in the United Kingdom Prospective Diabetes Study. Fewer myocardial infarctions were seen with enalapril than with nisoldipine in the Appropriate Blood Pressure Control in Diabetes trial. Intense blood pressure control with felodipine, enalapril, and hydrochlorothiazide reduced overall cardiovascular events and mortality but not myocardial infarction and strokes in the Hypertension Optimal Treatment trial. Nitrendipine alone or together with enalapril and hydrochlorothiazide decreased fatal and nonfatal strokes and cardiovascular mortality but not myocardial infarctions in the Systolic Hypertension in Europe trial These trials, in aggregate, reinforce the importance of intense blood pressure control, which can be achieved only with combination drug therapy rather than a specific monotherapy drug class recommendation.
AB - Diabetes mellitus without previous myocardial infarction carries the same risk of a future myocardial infarction as someone who has had one. Intense glucose, lipid, and blood pressure control in diabeti patients is advocated to reduce cardiovascular events and decrease the incidence of end-stage renal disease, retinal damage, and peripheral vascular disease. Recent studies, including the Systolic Hypertension in the Elderly Program, indicate that low-dose diuretics, compared with placebo, reduce fatal and nonfatal myocardial infarctions but not fatal and nonfatal stroke in diabetic patients. Similarly, captopril (and diuretics) compared with diuretics and β-blockers decreased fatal and nonfatal myocardial infarctions but not fatal and nonfatal strokes in the Captopril Prevention Project. Intense blood pressure therapy with captopril and intense blood pressure therapy with atenolol equally lowered macrovascular and microvascular events compared with less intense blood pressure treatment in the United Kingdom Prospective Diabetes Study. Fewer myocardial infarctions were seen with enalapril than with nisoldipine in the Appropriate Blood Pressure Control in Diabetes trial. Intense blood pressure control with felodipine, enalapril, and hydrochlorothiazide reduced overall cardiovascular events and mortality but not myocardial infarction and strokes in the Hypertension Optimal Treatment trial. Nitrendipine alone or together with enalapril and hydrochlorothiazide decreased fatal and nonfatal strokes and cardiovascular mortality but not myocardial infarctions in the Systolic Hypertension in Europe trial These trials, in aggregate, reinforce the importance of intense blood pressure control, which can be achieved only with combination drug therapy rather than a specific monotherapy drug class recommendation.
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U2 - 10.1007/s11906-996-0024-9
DO - 10.1007/s11906-996-0024-9
M3 - Article
C2 - 10981115
AN - SCOPUS:0033290664
SN - 1522-6417
VL - 1
SP - 512
EP - 520
JO - Current Hypertension Reports
JF - Current Hypertension Reports
IS - 6
ER -