Speaker Abstract

Hypertension, Its Management and Outcomes

S George Carruthers MD, London Health Sciences Centre and the University of Western Ontario, London, Ontario, Canada N6A 4G5.

The combination of hypertension and diabetes greatly aggravates the progressive cardiovascular morbidity and mortality associated with aging and other cardiovascular risk factors. Two major clinical trials published during the past year provide evidence that aggressive lowering of blood pressure can reduce cardiovascular morbidity and mortality in hypertensive diabetics [1.2].

In the Hypertension Optimal Treatment (HOT) Study [1] 1501 patient (8%) were diabetic. Fatal and nonfatal myocardial infarctions, fatal and nonfatal strokes and all other cardiovascular deaths were reduced from 24.4 events per 1000 patient-years in the <90 mmHg group to 11.9 events in the <80 mmHg group, p-value for trend 0.005. Cardiovascular mortality dropped from 11. 1 to 3.7 per 1000 patient-years, p-value for trend 0.016.

The United Kingdom Prospective Diabetes Study investigated tight blood pressure control and risk of macrovascular and microvascular complications in Type 2 diabetes [2]. A total of 1,148 patients entered the hypertension in diabetes substudy. Patients randomized to tight control of blood pressure (target <150/85 mmHg) achieved an average blood pressure of 144/82. There was a reduction in any diabetes-related endpoint by 24%, p=0.0046; a decrease in diabetes-related death by 32%, p=0.019; a reduction in stroke by 44%, p=0.013; a reduction in microvascular disease by 37%, p=0.0092; a reduction by heart failure by 56%, p=0.0043; a delay in retinopathy progression by 34%, p=0.0038 and less deterioration of vision by 47%, p=0.0036. There was no difference in BP lowering or clinical outcomes between the ACEI and beta-blocker based protocols.

1. Hansson L, Zanchetti A, Carruthers SG, et al. Lancet 1998; 351: 1755-62.
2. UK Prospective Diabetes Study Group. UKPDS 38. BMJ 1998; 317: 703-713.