Diabetes with hypertension medical therapy: Difference between revisions
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(/* Study Name: Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial, (FACET), 1998 {{cite journal| author=Tatti P, Pahor M, Byington RP, Di Mauro P, Guarisco R, Strollo G et al.| title=Outcome results of the Fosinopril Versus Amlodi...) |
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* '''Exclusion criteria'''- History of [[coronary heart disease]] or [[stroke]], serum [[creatinine]] > 1.5 mg/dl, [[albuminuria]] > 40 micrograms/min, and use of lipid-lowering drugs, [[aspirin]], or antihypertensive agents other than [[beta-blocker]]s or [[diuretic]]s. | * '''Exclusion criteria'''- History of [[coronary heart disease]] or [[stroke]], serum [[creatinine]] > 1.5 mg/dl, [[albuminuria]] > 40 micrograms/min, and use of lipid-lowering drugs, [[aspirin]], or antihypertensive agents other than [[beta-blocker]]s or [[diuretic]]s. | ||
* '''Study results''': Fosinopril lowered the risk of the composite endpoints of acute [[myocardial infarction]], stroke, or hospitalization due to [[angina]] more compared to amlodipine (hazards ratio = 0.49, 95% CI = 0.26-0.95). However, no significant difference in total [[serum cholesterol]], [[HDL cholesterol]], [[HbA1c]], fasting serum glucose, or plasma insulin was found. | * '''Study results''': Fosinopril lowered the risk of the composite endpoints of acute [[myocardial infarction]], stroke, or hospitalization due to [[angina]] more compared to amlodipine (hazards ratio = 0.49, 95% CI = 0.26-0.95). However, no significant difference in total [[serum cholesterol]], [[HDL cholesterol]], [[HbA1c]], fasting serum glucose, or plasma insulin was found. | ||
===Hypertension/ Blood Pressure Control=== | |||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' '''Screening and diagnosis:''' Blood pressure should be measured at every routine visit. Patients found to have elevated blood pressure should have blood pressure confirmed on a separate day. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' '''Goals:''' | |||
*People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
*Lower systolic targets, such as <130 mmHg, may be appropriate for certain individuals, such as younger patients, if it can be achieved without undue treatment burden. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
*Patients with diabetes should be treated to a diastolic blood pressure <80 mmHg.. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' '''Treatment:''' | |||
*Patients with a blood pressure <120/ 80 mmHg should be advised on life- style changes to reduce blood pressure. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
*Patients with confirmed blood pressure ≥140/80 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely subsequent titration of pharmacological therapy to achieve blood pressure goals. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
*Lifestyle therapy for elevated blood pressure consists of weight loss, if overweight; Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern including reducing sodium and increasing potassium intake; moderation of alcohol intake; and increased physical activity. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
*Pharmacological therapy for patients with diabetes and hypertension should be with a regimen that includes either an ACE inhibitor or an angiotensin receptor blocker (ARB). If one class is not tolerated, the other should be substituted. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
*Multiple-drug therapy (two or more agents at maximal doses) is generally required to achieve blood pressure targets. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
*Administer one or more antihypertensive medications at bedtime. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
*If ACE inhibitors, ARBs, or diuretics are used, serum creatinine/estimated glomerular filtration rate (eGFR) and serum potassium levels should be monitored. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: E]])''<nowiki>"</nowiki> | |||
*In pregnant patients with diabetes and chronic hypertension, blood pressure target goals of 110–129/65–79 mmHg are suggested in the interest of long- term maternal health and minimizing impaired fetal growth. ACE inhibitors and ARBs are contraindicated during pregnancy. ''([[ADA guidelines classification scheme#Level of Evidence|Level of Evidence: E]])''<nowiki>"</nowiki> | |||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 14:28, 18 December 2013
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Diabetes mellitus Main page |
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Patient Information |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]
Overview
Hypertension is a common co-morbidity associated with patients of diabetes, especially type 2 diabetes. Co-existence of these conditions strongly predispose patients to both renal as well as cardiovascular (CV) injury. Diabetes is the most common cause of end-stage renal disease in the United States. The 1994 Working Group Report on Hypertension and Diabetes, has recommended the original blood pressure goals of less than 130/85 mmHg to preserve renal function and reduce cardiovascular events in these groups of patients.
Treatment
The preferred treatment of the diabetic with hypertension includes:
- ACE inhibitors which may provide benefits above and beyond control of hypertension including delaying progression of renal disease.
- Calcium channel blockers
- Low dose diuretics
Supportive Trial Data
Study Name: LIFE Study, 2002 [1]
- Study design: Double blinded, randomised, parallel-group trial
- Sample size: 1195 patients with diabetes, hypertension, left ventricular hypertrophy (on electrocardiograms)
- Study drugs: Losartan or Atenolol
- Study period: 4 years
- Study results: Losartan was found to be more effective than atenolol in reducing composite endpoints like cardiovascular morbidity and all causes mortality in patients with hypertension, diabetes, and left-ventricular hypertrophy.
Study Name: Candesartan and Lisinopril Microalbuminuria (CALM) Study, 2000 [2]
- Study design: Double blinded, prospective, randomised, parallel-group, multicenteric (4 countries, 37 centers) trial
- Sample size: 199 patients with diabetes & hypertension
- Study drugs: Candesartan or lisinopril
- Study period:
- Placebo run in period-4 weeks
- 12 weeks Candesartan or lisinopril
- Followed by 12 weeks' monotherapy or combination treatment
- Study question: Compare the effects of candesartan or lisinopril, or both, on blood pressure and urinary albumin excretion , hypertension, and type 2 diabetes.
- Study results: Candesartan was found to be as effective as lisinopril in reducing blood pressure and microalbuminuria in hypertensive type 2 diabetics. Combination treatment (Candesartan+lisinopril) was well tolerated and more effective in reducing blood pressure compared to either drugs alone.
Study Name: Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial, (FACET), 1998 [3]
- Study design: Open label, randomized trial
- Sample size: 380 hypertensive diabetics patient
- Study drugs: Fosinopril (20 mg/day) or amlodipine (10 mg/day)
- Study period: 3.5 years
- Inclusion criteria- NIDDM and hypertension (SBP > 140 mmHg or DBP > 90 mmHg).
- Exclusion criteria- History of coronary heart disease or stroke, serum creatinine > 1.5 mg/dl, albuminuria > 40 micrograms/min, and use of lipid-lowering drugs, aspirin, or antihypertensive agents other than beta-blockers or diuretics.
- Study results: Fosinopril lowered the risk of the composite endpoints of acute myocardial infarction, stroke, or hospitalization due to angina more compared to amlodipine (hazards ratio = 0.49, 95% CI = 0.26-0.95). However, no significant difference in total serum cholesterol, HDL cholesterol, HbA1c, fasting serum glucose, or plasma insulin was found.
Hypertension/ Blood Pressure Control
| "1. Screening and diagnosis: Blood pressure should be measured at every routine visit. Patients found to have elevated blood pressure should have blood pressure confirmed on a separate day. (Level of Evidence: B)" |
"2. Goals:
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"3. Treatment:
|
References
- ↑ Lindholm LH, Ibsen H, Dahlöf B, Devereux RB, Beevers G, de Faire U; et al. (2002). "Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol". Lancet. 359 (9311): 1004–10. doi:10.1016/S0140-6736(02)08090-X. PMID 11937179. Review in: ACP J Club. 2002 Nov-Dec;137(3):87
- ↑ Mogensen CE, Neldam S, Tikkanen I, Oren S, Viskoper R, Watts RW; et al. (2000). "Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study". BMJ. 321 (7274): 1440–4. PMC 27545. PMID 11110735.
- ↑ Tatti P, Pahor M, Byington RP, Di Mauro P, Guarisco R, Strollo G; et al. (1998). "Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM". Diabetes Care. 21 (4): 597–603. PMID 9571349.