Hypertension's Link with Diabetes and Cardiovascular Events

The good news for those with an interest in hypertension, is that recent statistics demonstrate the US has succeeded in controlling blood pressure in 50% of patients with hypertension, George L. Bakris, MD, told the audience in his presentation, “Hypertension in Type 2 Diabetes.”

But questions remain about the guidelines that suggest a target of 130/80 is the optimal number physicians should aim for in their diabetic patients.

Bakris is a professor of medicine, at the University of Chicago Pritzker School of Medicine.

Like many of the presenters at the Cardiometabolic Health Congress, Bakris highlighted the Accord Study as one source of information on whether the guideline should be changed. The study involved patients with established type 2 diabetes, who were at high risk for cardiovascular disease. The study contained three clinical trials to determine strategies to decrease the high rate of cardiovascular disease events.

There were three main approaches:

-One approach compared intensive blood sugar treatment compared to standard glucose care.

-Another approach involved intensive blood pressure treatment compared to standard blood pressure treatment.

-The third approach sought to treat multiple blood lipids by either administering a fibrate plus a statin or a statin alone.

The results of the intensive blood pressure lowering group demonstrated that the systolic blood pressure levels were lowered to 120 and maintained throughout the sudy; this group also, towards the end of the trial, manifested more hypotension and bradycardia. While there was no significant difference among the two groups in the time to first occurrence of a heart attack, stroke, or cardiovascular death, the intensive group did demonstrate a significant reduction in the rate of strokes.

Bakris also highlighted the INVEST trial, which involved 22,000 participants with coronary disease, with a diabetic subgroup of 6400 patients. All the participants had blood pressure less than systolic 140. The study demonstrated that a calcium-channel-blocker-based strategy was just as effective as an initial beta blocker approach to treat patients with coronary artery disease. The study also had some participants attempt to achieve the target of systolic blood pressure 130 or lower and the other group below 140. Results demonstrated that a level below 130 was not more effective in reducing cardiovascular events, however, Basrik said.

Basrik also discussed markers of Diabetes Mellitus Nephropathy and specifically the role of microalbuminuria. While previously, it was thought that microbuminuria was a clinical factor in mesangial expansion, recent research demonstrates that it is not related to kidney disease in diabetes.

What Bakris said was clear was the need for combination therapy for those with hypertension, and kidney disease. Among alternatives for blood pressure approaches, Basrik highlighted amlodipine and ACE inhibitors as a combination therapy that may be used.