The guidelines reflect evidence that treating high blood pressure in patients with type 2 diabetes dramatically decreases their risk for heart disease, stroke, and early death. Some 16 million Americans in the United States, or about 6 percent of the population, have type 2 diabetes. Eleven million people have both type 2 diabetes and high blood pressure. Up to 80 percent of all people with type 2 diabetes will develop or die from blood vessel or heart disease.
"Most of the focus in diabetes care has been on tight control of blood sugar," said Vincenza Snow, MD, senior medical associate of scientific policy at ACP and an author of the guidelines. "We want both doctors and patients to know that aggressive blood pressure control is also important in managing diabetes." ACP recommends that patients with diabetes and high blood pressure aim for blood pressure levels of less than 135/80 mm Hg.
The guidelines say both thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors can be used as first-line agents to control blood pressure in most patients with diabetes. "But even in the best-designed studies, most patients did not reach target blood pressure levels with just one drug," said Snow. "Patients should know that they probably will need to take more than one medication to control their blood pressure."
The guidelines were based on a review of the evidence about blood pressure, cardiovascular complications, and death in people with type 2 diabetes. The authors used these studies to identify the benefits of blood pressure control, the ideal blood pressure levels, and the most effective blood pressure drugs in people with type 2 diabetes. They concluded that further studies are needed to determine the relative contributions of glucose and blood pressure control to poor health outcomes in diabetes.
The manuscripts published in Annals were peer-reviewed by the American Diabetes Association, the National Diabetes Education Program, and the American Academy of Family Physicians. Internists and endocrinologists (subspecialists of internal medicine) treat the majority of people with type 2 diabetes in the United States.
The ACP guidelines are also the subject of a video news release, part of the Internal Medicine Report VNR series produced by the American College of Physicians. The diabetes VNR will be released at 5 p.m. on Monday, March 31, 2003. Downlink times and coordinates:
Monday, March 31, 2003, 09:00 - 9:30 AM EST and 14:00 – 14:30 PM EST (2 – 2:30 PM), Telstar 6 Transponder 11 (C) Band, Downlink Freq. 3920 (V).
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include more than 115,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illnesses in adults, reflected in the organization's trademarked phrase Doctors of Internal Medicine. Doctors for Adults.® ACP, formerly the American College of Physicians-American Society of Internal Medicine, changed its name to American College of Physicians on March 31.
NOTES TO EDITOR:
Both Dr. Snow and a Philadelphia patient are available for interviews. Call Susan Anderson, 215-351-2653.
Copies of the guidelines, "The Evidence-Base for Tight Blood Pressure Control in the Management of Type 2 Diabetes Mellitus," and background paper, "Treatment of Hypertension in Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice of Agents, and Setting Priorities in Diabetes Care," can be obtained by calling the ACP Communications Department at 1-800-523-1546, ext. 2656 or 215-351-2656.
Journal
Annals of Internal Medicine