Lower blood pressure to manage type 2 diabetes

A small reduction in blood pressure produced a significant benefit in the largest study ever done on the treatment of patients with type 2 diabetes, presented on Sunday in Vienna at the European Society of Cardiology Congress, and published online in the Lancet the same day.

Stephen MacMahon, Ph.D., M.P., described the results of ADVANCE, a randomized, placebo-controlled study in which 11,140 patients received either placebo or a single pill containing a fixed combination of an ACE inhibitor (perindopril) and a thiazide-like diuretic (indapamide). While the reduction in blood pressure was modest (an average of 5.6/2.2 mm Hg), at 4.3 years the treated group had a relative risk reduction of 14 percent for coronary heart disease events, 18 percent for cardiovascular deaths, 14 percent for deaths of any cause, and 21 percent for developing new or worsening kidney disease.

Daniel W. Jones, M.D., President of the American Heart Association, commented, "We spend both great effort and considerable financial resources in trying to treat diabetes effectively, and here is a simple and inexpensive way to save lives. Just lower the blood pressure!"

MacMahon calculated that one death could be avoided among every 78 patients treated for five years. Because type-2 diabetes is so common worldwide, he added that treatment such as this could prevent as many as 1.5 million deaths, even if given to only half of the world's diabetics.

The benefit for treated patients was seen both in the group who began with blood pressures above 140/90 and those who began at levels below this cut-off. It was also apparent whether or not patients were also on other blood- pressure-lowering drugs, statins, ACE inhibitors, and aspirin.

The American Heart Association points out that the majority of deaths in diabetic patients are due to cardiovascular disease. Dr. Jones added, "Having diabetes alone elevates an individual's risk to the same level as having coronary artery disease itself, and this means that we and our patients must work together to control all risk factors as well as possible. Diabetic patients should work with healthcare professionals to assure control of all risk factors including maintaining blood pressure levels under 130/85."

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