Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Hypertension Reports
Published in: Current Hypertension Reports 7/2015

01-07-2015 | Novel Treatments for Hypertension (T Unger, Section Editor)

Benefit of Blood Pressure Control in Diabetic Patients

Author: Ulrich Kintscher

Published in: Current Hypertension Reports | Issue 7/2015

Login to get access

Abstract

The coexistence of arterial hypertension and diabetes represents a devastating partnership for cardiovascular health. Thus, blood pressure and blood glucose control are essential therapeutic goals to reduce cardiovascular risk and other diabetes-related endpoints in these patients. The major benefit of blood pressure lowering in diabetes comes from a marked reduction of cardiovascular and renal endpoints. New target blood pressure values to achieve maximum cardiovascular and renal protection will be discussed. In addition to the reduction of macrovascular endpoints, blood pressure lowering therapy in diabetic patients has also been discussed to improve microvascular diseases during diabetes, in particular microalbuminuria or diabetic retinopathy. However, current clinical trial evidence is less robust than for macrovascular disease. Clinical studies showed controversial results, and will be discussed. Finally, new data from the ADVANCE-ON study about the long-term, sustained benefit of blood pressure lowering in hypertensive, diabetic patients has been recently published, and will be evaluated in the context of previous evidence. In summary, the present article will discuss selected new topics in the field of hypertension and diabetes focusing on the benefits achieved by blood pressure lowering in these patients.
Literature
1.
Kannel WB, Wilson PW, Zhang TJ. The epidemiology of impaired glucose tolerance and hypertension. Am Heart J. 1991;121(4 Pt 2):1268–73.PubMedCrossRef
2.
Tarnow L, Rossing P, Gall MA, Nielsen FS, Parving HH. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabetes Care. 1994;17(11):1247–51.PubMedCrossRef
3.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16(2):434–44.PubMedCrossRef
4.•
Do DV, Wang X, Vedula SS, Marrone M, Sleilati G, Hawkins BS, et al. Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev. 2015;1:CD006127. This study provides a recent excellent overview over the clinical studies investigating the importance of blood pressure for the prevention and progression of diabetic retinopathy.PubMed
5.
Menne J, Chatzikyrkou C, Haller H. Microalbuminuria as a risk factor: the influence of renin-angiotensin system blockade. J Hypertens. 2010;28(10):1983–94.PubMedCrossRef
6.••
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357. This publication provides the recent European guidelines for the management of arterial hypertension including specific sections about patients with hypertension and diabetes.PubMedCrossRef
7.•
Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2015;313(6):603–15. This review and meta-analysis corroborates the benficials actions of blood pressure lowering in diabetic patients.PubMedCrossRef
8.
Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;15:15.
9.
Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351(9118):1755–62.PubMedCrossRef
10.
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991;265(24):3255–64.
11.
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. Bmj. 1998;317(7160):703–13.
12.
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet. 2000;355(9200):253–9.
13.
Tuomilehto J, Rastenyte D, Birkenhager WH, Thijs L, Antikainen R, Bulpitt CJ, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med. 1999;340(9):677–84.PubMedCrossRef
14.
Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358(9287):1033–41.
15.
Patel A, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007;370(9590):829–40.PubMedCrossRef
16.
Kintscher U. New targets for blood pressure lowering in diabetic patients? Dtsch Med Wochenschr. 2010;135(48):2417–9.PubMedCrossRef
17.
Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus. N Engl J Med. 2010;14:14.
18.
Cederholm J, Gudbjornsdottir S, Eliasson B, Zethelius B, Eeg-Olofsson K, Nilsson PM. Blood pressure and risk of cardiovascular diseases in type 2 diabetes: further findings from the Swedish National Diabetes Register (NDR-BP II). J Hypertens. 2012;30(10):2020–30.PubMedCrossRef
19.
Cooper-DeHoff RM, Gong Y, Handberg EM, Bavry AA, Denardo SJ, Bakris GL, et al. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA. 2010;304(1):61–8.PubMedCentralPubMedCrossRef
20.
Redon J, Mancia G, Sleight P, Schumacher H, Gao P, Pogue J, et al. Safety and efficacy of low blood pressures among patients with diabetes: subgroup analyses from the ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial). J Am Coll Cardiol. 2012;59(1):74–83.PubMedCrossRef
21.••
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. This publication provides the recent JNC8 guidelines for the management of arterial hypertension including specific sections about patients with hypertension and diabetes.PubMedCrossRef
22.
23.••
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A. Target blood pressure in elderly hypertensive patients and in patients with diabetes mellitus. J Hypertens. 2014;32(8):1551–2. This publication elegantly discusses current controversies between the ESH/ ESC- and JNC8-guidelines on recommendations related to elderly patients and patients with diabetes.PubMedCrossRef
24.•
Diederichs C, Neuhauser H. Regional variations in hypertension prevalence and management in Germany: results from the German Health Interview and Examination Survey (DEGS1). J Hypertens. 2014;32(7):1405–13. The report provides the most current data on hypertension prevalence and management in Germany.PubMedCrossRef
25.
Godet-Mardirossian H, Girerd X, Vernay M, Chamontin B, Castetbon K, de Peretti C. Patterns of hypertension management in France (ENNS 2006–2007). Eur J Prev Cardiol. 2012;19(2):213–20.PubMedCrossRef
26.
Haller H, Ito S, Izzo Jr JL, Januszewicz A, Katayama S, Menne J, et al. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med. 2011;364(10):907–17.PubMedCrossRef
27.•
Wang B, Wang F, Zhang Y, Zhao SH, Zhao WJ, Yan SL et al. Effects of RAS inhibitors on diabetic retinopathy: a systematic review and meta-analysis. The lancet Diabetes & endocrinology. 2015. Interesting and up-to-date review/ meta-analysis on the protective actions of RAS-blockade in diabetic retinopathy
28.
29.
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89.PubMedCrossRef
30.••
Zoungas S, Chalmers J, Neal B, Billot L, Li Q, Hirakawa Y, et al. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Engl J Med. 2014;371(15):1392–406. A highly important publication reporting data from the follow-up observation period in the ADVANCE trial. Long-term benefits of blood pressure lowering were documented.m.PubMedCrossRef
Metadata
Title
Benefit of Blood Pressure Control in Diabetic Patients
Author
Ulrich Kintscher
Publication date
01-07-2015
Publisher
Springer US
Published in
Current Hypertension Reports / Issue 7/2015
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-015-0561-1

Other articles of this Issue 7/2015

Current Hypertension Reports 7/2015 Go to the issue

Preeclampsia (VD Garovic, Section Editor)

Secondary Hypertension in Pregnancy

Pulmonary Hypertension (J Klinger, Section Editor)

Medical Therapies for the Treatment of Pulmonary Arterial Hypertension: How Do We Choose?

Novel Treatments for Hypertension (T Unger, Section Editor)

Antihypertensive Combination Treatment: State of the Art

Hypertension and the Kidney (RM Carey, Section Editor)

Aldosterone and the Mineralocorticoid Receptor: Risk Factors for Cardiometabolic Disorders

Resistant Hypertension (E Pimenta, Section Editor)

Blood Pressure in Older Adults: the Importance of Frailty

Preeclampsia (VD Garovic, Section Editor)

From Glomerular Endothelium to Podocyte Pathobiology in Preeclampsia: a Paradigm Shift
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits