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© Borgis - New Medicine 4/2003, s. 87-89
Zygmunt Chodorowski1, Jacek Sein Anand1, Barbara Cylkowska2, Marek Wisniewski1, Adam Hajduk1, Wojciech Waldman1
Assessment of antihypertensive treatment in elderly patients with type 2 diabetes
1 1st Department of Internal Medicine and Toxicology, The Medical University of Gdansk, Poland
Head: prof. Zygmunt Chodorowski, MD, PhD
2 Outpatient Department of Diabetology, Elblag, Poland
Head: Barbara Cylkowska, MD
Summary
Introduction: Type 2 diabetes and concominant hypertension are common medical phenomenon. More than half of the patients with type 2 diabetes have accompanying hypertension, which results in an almost threefold increase in the frequency of main cardiovascular event.
Methods: The study included 927 patients with type 2 diabetes referred to the outpatient Department of Diabetology from general outpatient clinics and hospitals of the former Elbląg district over the years 1993-2002.
Results: The patients were divided into 2 groups, according to age. Group I included 421 patients (276 women and 145 men, aged from 65 to 94; mean 72.6 yes.). Group II consisted of 506 patients (239 women and 267 men aged from 33 to 64; mean 54.9 yrs.).
The arterial blood pressure <130/80 were found in 6.4% of patients in group I, and in 12.6% of cases in group II. In both groups the precentages of efficiency treated patients were similar. The extent of single-drug therapy was similar in both groups. The most frequently administered drugs were ACE inhibitors (72.5%), calcium channel blockers (42%) and thiaside and thiazide-derivatives diuretics (40%).
Conclusions: The recommended antihypertensive treatment was offered to contiously, and was threrefore hardly effective.
Type 2 diabetes and concomitant hypertension are a common medical phenomenon. According to Kaplan, more than half of the patients with type 2 diabetes have accompanying hypertension, which results in an almost threefold increase in the frequency of main cardiovascular events, including, first of all, complications of ischaemic heart disease, and cerebral strokes (1). Many extensive research programmes have provided unquestionable evidence of multifactorial benefits of antihypertensive treatment in patients with hypertension complicating diabetes (2-7). The United Kingdom Diabetes Prospective Study (UKDPS) showed that a reduction in the mean systolic pressure by each 10 mmHg, resulted in decreased incidence of myocardial infarction by 11%, fatal and nonfatal cerebral strokes by 19%, microangiopathic diabetic complications by 13% (8). Some authors, however, emphasize that in the antihypertensive treatment, a wide range of available antihypertensive drugs is not used sufficiently, and the arterial pressure levels obtained in many patients, exceed, to a different extent, the projected target values (9, 10).

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Piśmiennictwo
1. Kaplan N.M.: Management of hypertension in patients with type 2 diabetes mellitus: guidelines based on current evidence. Ann. Intern. Med. 2001; 135:1079-83. 2. UKPDS Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). Br. Med. J. 1998; 317:703-13. 3. Hansson L. et al.: Effects of intensive blood-pressure lowering and low dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. HOT Study Group. Lancet 1998; 351:1755-62. 4. Heart Outcomes Prevention Evaluation Study Investigators: Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355:253-59. 5. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002; 288:2981-97. 6. Chobanian A.V. et al.: National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Progrem Coordination Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560-72. 7. Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J. Hypertens. 2003; 21:1011-53. 8. Adler A.I. et al.: Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. Br. Med. J. 2000; 321:412-19. 9. Berlowitz D.R. et al.: Hypertension management in patients with diabetes: the need for more aggressive therapy. Diabetes Care. 2003; 26:355-9. 10. Pellegrini F. et al.: for QuED Study Group. Role of organizational factors in poor blood pressure control in patients with type 2 diabetes: the QuED Study Group – quality of care and outcomes in type 2 diabetes. Arch. Intern. Med. 2003; 163:473-80. 11. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch. Intern. Med. 1997; 157:2413-46. 12. Bakris G.L.: A practical approach to acheving recommended blood pressure goals in diabetic patients. Arch. Intern. Med. 2001; 161:2661-7. 13. Basta E., Bakris G.: Choices and goals in the treatment of the diabetic hypertensive patient. Curr. Hypertens. Rep. 2001; 3:387-91. 14. Weir M.R.: Diabetes and hypertension: how low should you go and with which drugs? Am. J. Hypertens. 2001; 14:17S-26S. 15. Vijan S., Hayward R.A.: Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann. Intern. Med. 2003; 138:593-602.
New Medicine 4/2003
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