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1 April 2003 | Volume 138 Issue 7 | Pages 593-602
Background: Hypertension in patients with type 2 diabetes mellitus is a prevalent condition that leads to substantial morbidity and mortality.
Purpose: To evaluate the goals and optimal agents for treatment of hypertension in type 2 diabetes.
Data Sources: Review of the medical literature
Study Selection: Randomized trials that evaluated the pharmacologic treatment of hypertension in patients with diabetes and reported microvascular and macrovascular outcomes.
Data Extraction: Studies were identified by using the Cochrane Library, MEDLINE, meta-analyses, review articles, and expert recommendation. The searches of the Cochrane Library and MEDLINE were performed in May 2000 and updated in April 2002. Data were abstracted to standardized forms by a single reviewer and were confirmed by a second reviewer.
Data Synthesis: Treatment of hypertension in type 2 diabetes provides dramatic benefit. Target diastolic blood pressures of less than 80 mm Hg appear optimal; systolic targets have not been as rigorously evaluated, but targets of 135 mm Hg or less are reasonable. Studies that compare drug classes do not suggest obviously superior agents. However, it is reasonable to conclude that thiazide diuretics, angiotensin-II receptor blockers, and perhaps angiotensin-converting enzyme (ACE) inhibitors may be the preferred first-line agents for treatment of hypertension in diabetes. ß-Blockers and calcium-channel blockers are more effective than placebo, but they may not be as effective as diuretics, angiotensin-II receptor blockers, or ACE inhibitors; however, study results are inconsistent in this regard.
Conclusions: Treatment of hypertension in type 2 diabetes, with blood pressure goals of 135/80 mm Hg, provides dramatic benefits. Thiazide diuretics, angiotensin II receptor blockers, and ACE inhibitors may be the best first-line treatments, although other agents are usually necessary and goals may not be achieved even with three or four agents. Aggressive blood pressure control may be the most important factor in preventing adverse outcomes in patients with type 2 diabetes.
Author and Article Information
From the Veterans Affairs Health Services Research, Development Center for Practice Management and Outcomes Research, University of Michigan, and Michigan Diabetes Research and Training Center, Ann Arbor, Michigan.
Grant Support: By a Veterans Affairs Health Services Research and Development Career Development Award (Dr. Vijan). The American College of Physicians provided an honorarium to the authors for conducting this review. This funding had no role in the design, conduct, or reporting of this review.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Sandeep Vijan, MD, MS, Veterans Affairs Health Services Research and Development, PO Box 130170, Ann Arbor, MI 48113-0170; e-mail, svijan{at}umich.edu.
Current Author Addresses: Drs. Vijan and Hayward: Veterans Affairs Health Services Research and Development, P.O. Box 130170, Ann Arbor, MI 48113-0170. CLINICAL GUIDELINES
Treatment of Hypertension in Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice of Agents, and Setting Priorities in Diabetes Care
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