Treatment of hypertension in diabetes mellitus

Czech version

Authors: Jiří Widimský Jr
Authors‘ workplace: III. interní klinika 1. LF UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Vnitř Lék 2015; 61(4): 335-337
Category: Reviews

Overview

Hypertension and diabetes mellitus (DM) are common diseases. Prevalence of hypertension in DM type II is 70–80 %. Goal blood pressure (BP) is around 130/80 mm Hg. RAS blockers (ACE inhibitors or AT₁ blockers) are considered as the drugs of choice because of the decrease of cardiovascular risk and prevention of nephropathy. Combination antihypertensive therapy is needed in 80–90 % of pts. Combination of RAS blocker and calcium channel blocker is clinically useful. Diuretics should be part of triple-combination. Low-dose spironolactone can be recommended in severe forms of hypertension. Pharmacological approach should involve also intervention of all other risk factors including BMI reduction in obese subjects. Some of new antidiabetic drugs may lead to significant BP decrease (gliflozines).

Key words:
diabetes mellitus – hypertension – treatment

Sources

1. Mancia G, Fagard R, Narkiewicz K 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 Hypertension 2013; 31(7): 1281–1357.

2. Filipovský J, Widimský J Jr, Ceral J et al. Diagnostické a léčebné postupy u arteriální hypertenze, verze 2012: Doporučení České společnosti pro hypertenzi. Vnitř Lék 2012; 58(10): 785–801.

3. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317(7160): 703–713. Erratum in BMJ 1999; 318(7175): 29.

4. Hansson L, Zanchetti A, Carruthers SG et al. Effect of intensive blood pressure lowering and low dose of aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351(9118): 1755–1762.

5. Staessen JA, Thijs L, Fagard R et al. Effects of immediate versus delayed antihypertensive therapy outcome in the Systolic Hypertension in Europe Trial. J Hypertens 2004; 22(4): 847–857.

6. Patel A. ADVANCE Collaborative Group, 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): 829–840.

7. Jamerson K, Weber MA, Bakris GL et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359(23): 2417–2428.

8. Cushman WC, Evans GW, Byington RP et al. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362(17): 1575–1585.

9. Lindholm LH, Ibsen H, Dahlhof B et al. 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 2002; 359(9311): 1004–1010.

10. Remuzzi G, Macia M, Ruggenenti P. Prevention and treatment of diabetic renal disease in type 2 diabetes: the BENEDICT study. J Am Soc Nephrol 2006; 17(4 Suppl 2): S90-S97.

11. Yusuf S, Sleight P, Pogue J et al. Heart Outcomes Prevention Evaluation study investigators. Effects of an angiotensin converting-enzyme inhibitor, ramipril, on cardiovascular events in high risk patients. N Engl J Med 2000; 342(3): 145–153.

12. Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345(12): 851–860.

13. Dahlöf B, Sever PS, Poulter NR et al. ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005; 366(9489): 895–906.

14. Agabiti Rosei E, Rizzoni D. Metabolic profile of nebivolol, a beta-adrenoceptor antagonist with unique characteristic. Drugs 2007; 67(8): 1097–1107.

15. Oxlund CS, Henriksen JE, Tarnow L et al. Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial. J Hypertens 2013; 31(10): 2094–2102.

16. Maliha G, Townsend RR. SGLT2 inhibitors: their potential reduction in blood pressure. J Am Soc Hypert 2015; 9(1): 48–53.