Hypertension (defined as a blood pressure 140/90 mmHg) is an extremely common comorbid condition in diabetes, affecting 20-60% of patients with diabetes, depending on obesity, ethnicity, and age. In type 2 diabetes, hypertension is often present as part of the metabolic syndrome of insulin resistance also including central obesity and dyslipidemia. In type 1 diabetes, hypertension may reflect the onset of diabetic nephropathy.
Hypertension substantially increases the risk of both macrovascular and microvascular complications, including stroke, coronary artery disease, and peripheral vascular disease, retinopathy, nephropathy, and possibly neuropathy. In recent years, adequate data from well-designed randomized clinical trials have demonstrated the effectiveness of aggressive treatment of hypertension in reducing both types of diabetes complications.
Treatment Hypertension
The most recent committee highlighted ALLHAT's findings in the revision of its guidelines, meaning the information will now be used for practical treatments. The committee states that when compared to calcium channel blockers, ACE inhibitors and alpha blockers, thiazide-type diuretics are better first-line drug treatments for hypertensive patients. The diuretics excelled in controlling blood pressure, preventing cardiovascular events, are well tolerated by patients and are relatively inexpensive.
Methods We randomly assigned 3845 patients from Europe, China, Australasia, and Tunisia who were 80 years of age or older and had a sustained systolic blood pressure of 160 mm Hg or more to receive either the diuretic indapamide (sustained release, 1.5 mg) or matching placebo. The angiotensin-converting-enzyme inhibitor perindopril (2 or 4 mg), or matching placebo, was added if necessary to achieve the target blood pressure of 150/80 mm Hg. The primary end point was fatal or nonfatal stroke.
Pills as a treatment for hypertension have hardly solved the problem. Even if you're taking pills, your risk of dying from cardiovascular disease is still at least two to three times higher than that of people whose blood pressure is optimal - 110/70 or less.
Slightly raised blood pressure may not need to be treated so aggressively, but regular monitoring is important. If you have very severe high blood pressure, you may need to go to hospital for treatment. But it's much more likely that you will be cared for by your GP and/or a nurse.
The results of OHTS proved that topical medication does reduce the incidence of glaucoma. After five years of following the patients recruited, we determined that eyedrop treatment reduced the development of glaucoma by more than 50 percent.
Most clinicians would consider some type of treatment for patients whose diastolic pressure (the bottom number) is above 95 and/or whose systolic pressure (the top number) is above 160. For patients with pressures immediately below these figures (140-160/90-95), the doctor will take into account age and other individual factors before recommending any medical treatment.
In the past there have been observations that people over 80 with higher than average blood pressure do better than those with low blood pressure but that's not necessarily because high blood pressure's good for you. It's more that at that age having low blood pressure is often a sign you have something serious wrong with you. Another fear was that blood pressure treatment would make people dizzy and more likely to fall.
by james sameul
