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[IP] Treating Hypertension in the Patient with Type 2 Diabetes

  Clinical Advisory:
Treating Hypertension <http://www.nih.gov/news/pr/may2000/nhlbi-30.htm>  in
the Patient with Type 2 Diabetes
Statement by Claude Lenfant, M.D., Director National Heart, Lung, and Blood

National Heart, Lung, and Blood Institute (NHLBI)
30 May 2000

A new clinical advisory issued by the National High Blood Pressure Education
Program (NHBPEP) recommends that physicians pursue a more aggressive
treatment approach to lower the blood pressure of patients who have both
hypertension and diabetes. 

The NHBPEP is coordinated by the National Heart, Lung, and Blood Institute
(NHLBI) of the National Institutes of Health. The "2000 Clinical Advisory
Treatment of Hypertension and Diabetes," is published in the latest issue of
The Journal of Clinical Hypertension. 

Both diabetes and hypertension are independent risk factors for
cardiovascular disease (CVD). The advisory indicates that the coexistence of
these conditions in a patient imposes a need for a significantly lower goal
blood pressure (135/80 mm Hg) than the goal blood pressure recommended for a
patient with hypertension who does not have diabetes (140/90 mm Hg). Over 5
million Americans have type 2 diabetes and high blood pressure. Uncontrolled
hypertension leads to stroke, heart failure, and kidney failure. It is clear
that the combination of these two CVD risk factors has important public
health implications. 

This new report is part of a series of clinical advisories being issued by
NHLBI to raise health professional and consumer awareness of the health
dangers posed by high blood pressure. On May 4, 2000, NHLBI issued a
clinical advisory to draw attention to the problem of high systolic blood
pressure. Systolic blood pressure measures the force exerted by the blood as
it flows through the arteries when the heart contracts. It is expressed as
the top number of the blood pressure reading and now is recognized to be the
most important indicator of heart disease risk in adults age 60 and older. 

The authors of the new advisory note results from several studies showing
that efforts to lower high blood pressure in patients with type 2 diabetes
produce dramatic results. In one study, near optimal control of hypertension
(144/82 mm Hg) led to 44 percent fewer diabetes-related strokes, 37 percent
fewer cases of small blood vessel damage due to diabetes (particularly
diabetic retinopathy), and 32 percent fewer diabetes-related deaths. Another
study reported CVD deaths were reduced 76 percent in hypertensive patients
who had type 2 diabetes and 13 percent in patients who had hypertension but
no diabetes. 

The clinical advisory is an update to the Sixth Report of the Joint National
Committee on Prevention, Detection, and Treatment of High Blood Pressure
(JNC VI). JNC VI was produced in 1997 by the NHBPEP, a federation of 45
professional, voluntary, and official agencies. 

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