Hypertension and the Type 2 Diabetic

We're all aware that tight control of blood sugar in the Type 2 diabetic patient reduces the incidence of diabetic complications.¹ Now two articles in the September 12, 1998 edition of the BMJ suggest that tight control of Blood Pressure may be even more important in preventing these microvascular complications.

These studies², ³ compared the effect of tight control (BP mean 144/82) achieved with Captopril or Atenolol, with patients having looser BP control (mean 154/87). After 8.4 years it became apparent that the tight control group had a significant reduction in the incidence of diabetic complications and a significant reduction in mortality as compared to the less well controlled group.

Moreover this effect seemed to be secondary to the lowering of BP and not the specific effect of either drug. Both drugs lowered the BP equally well, and both often required the addition of one or two other antihypertensive medications to achieve satisfactory control.

Captopril was somewhat better tolerated by the patients and had a better discontinuation rate. It also had a slightly better effect on the complications of retinopathy and nephropathy when compared to atenolol.

This blood pressure study also confirms the importance of early treatment, including the concept of starting treatment early in all microalbuminuric patients, even those who are normotensive.⁴

A third study in this issue showed that tight blood pressure control is cost effective when compared with other widely used preventive strategies and is more feasible for most clinicians and patients than tight blood glucose control.⁵

This information is important as the number of diabetics we see continues to increase. There is now good evidence that tight control of sugar (Glycosylated Hemoglobin), tight BP control (140/85) and reduction of cholesterol (LDL 2.5) ⁶ can reduce the mortality and morbidity in our diabetic patients.

- John Hickey

Last updated December 21, 1998