Optimising treatment of hypertension to prevent cardiovascular complications in type 2 diabetes

Abstract

Diabetes is associated with an increased risk of cardiovascular disease which is amplified in the presence of hypertension. Tight control of blood pressure (BP) reduces cardiovascular events in patients with type 2 diabetes. It has been suggested that drugs which interrupt the renin-angiotensin system (RAS) may be superior to other classes of antihypertensive agents. This review assesses the evidence for this suggestion, focusing on recently reported trials including ALLHAT, ANBP2, LIFE, and SCOPE. The evidence suggests that antihypertensive agents which interrupt the RAS offer benefits for diabetic patients with multiple cardiovascular risk factors.

Keywords

type 2 diabetes renin-angiotensin system inhibition cardiovascular events.

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References

Management of type 2 diabetes; Inherited Clinical Guideline H. Management of blood pressure and blood lipids . National Institute for Clinical Excellence. October 2002.

Cooper ME , Johnston CI Optimizing treatment of hypertension in patients with diabetes. JAMA 2000;283:3177-9.

The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major Outcomes in high-risk hypertensive patients randomised to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002;288:2981-97.

Wing LM , Reid CM , Ryan P. et al. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003;348:583-92.

Heart Outcomes Prevention Evaluation (HOPE) Investigators. Effects ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus; results of the HOPE study and MICRO-HOPE sub-study. Lancet 2000;355:253-9.

PROGRESS Collaborative Group. Randomised trial of a perindoprilbased blood pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:1033-41.

Ruilope L. Proven benefits of angiotensin receptor blockers in the progression of renal disease. Eur Heart J 2003;5(suppl C):C9-C12.

Dahlof B. , Devereux RB , Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002;359:995-1003.

Lithell H. , Hansson L. , Skoog I. et al. For the SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003;21:875-86.

10.

Brown MJ , Cruickshank JK , Dominiczak AF et al. Better blood pressure control: how to combine drugs. J Hum Hypertens 2003;17:81-6.

11.

Mogensen CE , Neldam S. , Tikkanen I. et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes; the candesartan and lisonopril microalbuminuria (CALM) study. BMJ 2000;321:1440-4.