P-330: Diabetic hypertensive patient - guidelines for action and possible difficulties

• Published in: American journal of hypertension Vol. 14; no. S1; p. 139A
• Main Authors: Barroso, Weimar K. S., Jardim, Paulo C. V., Jardim, Thiago S. V., Souza, Claudio T. S., Magalhaes, Alessandro L. A., Couto, Priscila V. O., Monego, Estelamaris T.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2001
• Subjects: Guidelines for treatment; Hypertension and diabetes; Treatment
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/S0895-7061(01)01774-5

For hypertensive patients, the indication is to control BP in such a way as not to exceed <140/90mm Hg. In diabetic patients (DM) treatment goals are more rigorous (<130/85mm Hg), and it is recommended that ACE inhibitors be used as the first line of drugs. The authors evaluated BP control and other cardiovascular risk factors (CVRF) in diabetic patients, in a reference center For the treatment of Hypertension. Patients with Diabetes Mellitus (02 fasting glycemia curves>126 mg/dl and/or those who were taking hypoglycemic drugs or insulin) were studied. They were evaluated in the first (M1) and last visit (M2), in terms of BP, Body Mass Index (BMI), hypotensive drugs being used, glycemia, cholesterol (CT), creatinine and potassium. There were 146 patients with a diagnosis of Diabetes. Mean age was 61.65 years (range 32 to 90 years), and there were 27 males (18.5%) among those recruited for this study. Mean follow up was 5.5 years. (See Table) Variable M1 M2 Difference SP (mmHg) 161.6 146.3* -15.3 DP (mmHg) 99.9 89.5* -10.4 BMI(Kg/m2) 29.5 29.3 -0.2 Glycemia(mg/dL) 145.7 153.7 +8.0 Cholesterol(mg/dL) 218.8 221.8 +3.0 Creatinine(mg/dL) 0.94 0.85 -0.09 K+ 4.2 4.8 +0.6 p< 0,01 relative to M1 At M1, 10.4% of the patients were not taking any drugs, 50.6% were taking only one type of drug, 30.8% two, and 8.2% of the patients were taking three or more drugs. At M2, these figures changed to 10.9%, 39%, 39.7% and 10.4%, respectively. Diuretic drugs were the most prevalent (47.9% at M1 and 50.6% at M2). ACE inhibitors were used by 24.6% of the patients in the beginning and by 41.7% at the end. A significant decrease in BP (15.5/10.4mm Hg respectively, for SP and DP) was verified, but only 17.1% reached the BP<130x85 mm Hg goal, while only 41.7% were able to decrease BP levels to <140x90mm Hg. Other risk factors for cardiovascular diseases remained unchanged. The use of ACE inhibitors increased but not to desired levels. These data reinforce the need to use a more aggressive approach for these patients, despite social and economic limitations that could possibly interfere with treatment compliance.