Most diabetics need better BP control to reach targets

2 September 2010

MedWire News: Belgian researchers report that only 16% of patients with Type 2 diabetes achieve the target blood pressure (BP) of 130/80 mmHg recommended by American and European regulatory bodies such as the European Society of Hypertension.

This highlights “the need for a combined, proactive multifactorial approach to diabetes management and global residual vascular risk management,” say Michel Hermans (Cliniques Universitaires St-Luc, Brussels) and team.

“Many variables can negatively affect BP control... lack of discipline in keeping up with improved lifestyle habits has been estimated to account for over 8% of those patients not achieving BP targets,” they explain.

Aiming to identify why diabetic patients fail to adequately lower their BP, Herman and colleagues compared the sociodemographic and clinical characteristics of diabetic patients with a BP of <130/80 mmHg or <125/75 mmHg if proteinuric (goal-achievers [GAs], n=111) with those of diabetic patients with BP ≥130/80 mmHg or ≥125/75 mmHg (non-goal-achievers [non-GAs], n=562).

The researchers found that non-GAs had higher alcohol consumption, were often of sub-Saharan African origin, and had a lower level of education than GAs.

Fewer GAs used diet and exercise as their sole method of diabetic management than non-GAs, at 2% versus 4%.

No difference was observed between the rate of insulin use in both groups, or in the use of mono, bi, or tri-antidiabetic medication. Glitazones, however, were used more frequently by GAs than non-GAs.

Interestingly, more non-GAs used ≥4 antihypertensives than GAs, at 11% versus 5%, and no significant difference was found in the rate of mono or combination antihypertensive therapy use by both groups.

Of note, calcium-channel blockers were used significantly more by non-GAs than GAs, at 35% versus 19%. Conversely, lipid-lowering drugs, primarily statins, were used more by GAs than non-GAs, at 76% versus 60%.

Herman and colleagues conclude in the journal Diabetes and Metabolic Syndrome: Clinical Research and Reviews: “A more intensive approach to treating hypertension is therefore indicated in those patients not achieving BP targets.”

They suggest that this may be achieved by “combining drugs with different mechanisms of action [which] can indeed result in rapid and additive or even synergistic decreases in BP, often at lower doses.”

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Diab Met Syndr: Clin Res Rev 2010; Advance online publication