Diabetes Health Center
This article is from the WebMD News Archive
Hypertension Control Urged for Diabetes
March 31, 2003 -- Although the primary focus in diabetes management has been in controlling blood sugar levels, new guidelines emphasize the need for people with type 2 diabetes to also keep close tabs on another crucial number: Their blood pressure.
The guidelines, released today by the American College of Physicians for its members -- who treat the bulk of diabetes patients -- emphasizes the need for high blood pressure management in people with type 2 diabetes. As many as 11 million of the 16 million Americans with type 2 diabetes also have high blood pressure -- a systolic (top) reading of greater than 140 and a diastolic (bottom) number of more than 90. And up to 80% of people with diabetes eventually develop or die from blood vessel problems or other forms of heart disease, such as stroke or heart attacks.
But the guidelines, published in the March 31 issue of Annals of Internal Medicine, recommend that people with type 2 diabetes and high blood pressure maintain levels no higher than 135/80. The medical journal is published by the ACP, the nation's second largest medical association, and whose members include internists and other primary care specialists.
"We wrote the guidelines because we feel that diabetes is a very important problem in primary care, and up to now, the major focus has been on glycemic control," says Vincenza Snow, MD, of the ACP and lead author of the guidelines. "While that is very important, a lot of other things have been left to the wayside while everyone is working hard to get people's blood sugars under control. We felt that tight blood pressure control should be a really major focus in primary care for the management of type 2 diabetes; it really is as important."
Although the new guidelines are written for primary care doctors, Snow says that patients should be aware that high blood pressure is a major risk factor for heart disease. "And the fact they are diabetic increases the risk of heart attack, stroke, and heart disease even more," she tells WebMD. "These patients should be very aware of what their blood pressure numbers are and actively participate in their care by reminding their physicians that their numbers have to be even lower than non-diabetic people with high blood pressure."
Snow wrote the guidelines after evaluating studies on how high blood pressure affects people with type 2 diabetes. Three of those studies indicate that controlling high blood pressure dramatically decreases their risk of heart disease, stroke, and premature death, while the others suggest that diabetes patients fare best on certain classes of blood pressure medications.
In a related study published in the same issue of Annals, another team of researchers report that three types of antihypertensive medications -- thiazide diuretics, ACE inhibitors, or angiotensin 2 receptor blockers -- should be considered the first-line defense for lowering blood pressure in patients with diabetes. That finding is based on a review of previous research that evaluated these drugs, specifically in patients with type 2 diabetes and high blood pressure, against placebos, or other medications, including calcium-channel blockers.
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