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Antihypertensive therapy in diabetes mellitus: insights from ALLHAT and the Blood Pressure-Lowering Treatment Trialists’ Collaboration meta-analysis

Journal of Human Hypertension volume 19, pages 851–853 (2005)Cite this article

Type 2 diabetes mellitus (DM) is closely associated with hypertension, and the presence of both the conditions results in a high risk for the development of cardiovascular disease (CVD), renal impairment and diabetic retinopathy. Thus, most blood pressure (BP) management guidelines emphasise the importance of concomitant DM as part of overall cardiovascular risk assessment, and the need for more aggressive treatment targets.1 This approach is all the more important given the huge burden of hypertension on stroke and CVD, and the missed opportunities for prevention.2

How large is the problem of hypertension in the setting of DM? A recent large cross-sectional survey of over 250 000 patients from general practices across the United Kingdom recently reported that 56.2% of pharmacologically treated and 47.2% of diet-treated patients with DM had hypertension, as compared to 10.3% in those without DM.3 This was consistent with earlier reports, where the association between DM and hypertension has been demonstrated in up to 65% of patients with DM, having major implications for CVD risk.4, 5 However, what is clear is the greater benefits of appropriate BP treatment on CVD, compared to glycaemic control. For example, in the United Kingdom Prospective Study, a systolic and diastolic BP reduction by 10 mmHg and 5 mmHg respectively has greater CVD risk reduction than lowering glycated haemoglobin by a mean of 0.9%.6 This was further substantiated by the Hypertension Optimal Treatment Study, suggesting that there should perhaps be no lower threshold beyond which BP lowering is not considered to be beneficial in the setting of DM.7 The question therefore is not ‘Do we lower BP in diabetic hypertensive patients?’ …. but ‘How can we best lower BP?’

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Authors and Affiliations

  1. University Department of Medicine, City Hospital, Birmingham, UK

    G I Varughese & G Y H Lip

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  1. G I Varughese
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  2. G Y H Lip
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Correspondence to G Y H Lip.

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Competing Interests: GV and GL have received honoraria for educational symposia and lecturing, as well as research funding from various manufacturers of antihypertensive agents.

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Varughese, G., Lip, G. Antihypertensive therapy in diabetes mellitus: insights from ALLHAT and the Blood Pressure-Lowering Treatment Trialists’ Collaboration meta-analysis. J Hum Hypertens 19, 851–853 (2005). https://doi.org/10.1038/sj.jhh.1001926

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