Clinical Trials Relevant To Treatment Of Hypertension And Prevention Of Cardiovascular Complications In Diabetes

Treatment of hypertension is crucial for the reduction of cardiovascular complications. There have been a considerable number of prospective randomized trials showing the benefits of treating hypertension in diabetes. The SHEP (Systolic Hypertension in the Elderly Program) trial showed that treatment of isolated sys- -o tolic hypertension in elderly type 2 diabetic patients with a diuretic, chlorthali-done, was associated with a significant decrease in the 5-year rates of cardiovas- S

cular events and mortality compared to placebo (66). Similarly, in the Systolic Hypertension in Europe (Sys-Eur) Trial, treatment of isolated systolic hypertension in elderly patients with type 2 diabetes with an intermediate-acting calcium channel blocker, nitrendipine, showed a significant decline in cardiovascular J

& u events and mortality compared to placebo (67). In both of these studies, the absolute risk reduction with active treatment compared with placebo was significantly larger for diabetic versus nondiabetic patients, reflecting the higher cardiovascular risk seen in diabetic patients.

In the United Kingdom Prospective Diabetes Study (UKPDS), 1148 hypertensive patients with type 2 diabetes were randomized either to tight blood pressure control (defined as <150/85 mmHg) or to less tight blood pressure control (defined as <180/105 mmHg) (68). The less tight control group received treatment that excluded an ACE inhibitor or a beta-blocker, whereas the tight control group received either captopril or atenolol. Achieved mean blood pressure in the tight control group was 144/82 mmHg versus 154/87 mmHg in the less tight group (p < 0.0001) (Fig. 1). After a median follow-up of 8.4 years, even this small difference in blood pressure level (10/5 mmHg) yielded a 24% risk reduction in diabetic endpoints, 32% in diabetes-related deaths, 44% in stroke, and 37% in microvascular endpoints in patients in the tight blood pressure control group. Furthermore, these reductions were much greater than those achieved with intensive blood glucose control (69). In a separate analysis of the tight blood

Figure 1 Comparison of the mean systolic and diastolic blood pressures achieved in different target blood control groups of UKPDS, HOT, and ABCD trials. The blood pressures shown for the HOT trial are the means of both diabetic and nondiabetic patients included in this study. The blood pressures shown for the UKPDS and ABCD trials are the means of diabetic patients included in these studies. ■ = systolic blood pressure; □ = diastolic blood pressure; DBP = diastolic blood pressure; HT = hypertensive; NT = normotensive.

Figure 1 Comparison of the mean systolic and diastolic blood pressures achieved in different target blood control groups of UKPDS, HOT, and ABCD trials. The blood pressures shown for the HOT trial are the means of both diabetic and nondiabetic patients included in this study. The blood pressures shown for the UKPDS and ABCD trials are the means of diabetic patients included in these studies. ■ = systolic blood pressure; □ = diastolic blood pressure; DBP = diastolic blood pressure; HT = hypertensive; NT = normotensive.

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