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Blood pressure, antihypertensive treatment and factors associated with good blood pressure control in hypertensive diabetics: the Tarmidas study

Journal of Human Hypertension volume 21, pages 664–672 (2007)Cite this article

Abstract

Numerous population studies confirm the high prevalence of hypertension in type II diabetic (DM2) subjects and that intensive antihypertensive treatment is more beneficial to diabetic than to nondiabetic hypertensive subjects, yet not many of these are specific to Spain. To assess the degree of blood pressure (BP) control and the effects of antihypertensive drugs in the medical management of hypertension in diabetic patients in specialist care centres throughout Spain, we studied the socio-demographic, clinical and relevant laboratory parameters of 796 hypertensive patients with DM2 (mean age 66.09 (95% confidence interval (CI): 64.08–68.10). The percentage of diabetic patients responding positively to BP control measures was lower when compared to the nondiabetic population in both Spain and Europe. The degree of control was poorer for systolic than for diastolic BP, yet 40.6% of the patients were only on monotherapy. The fact that antihypertensive treatment was modified in only 40% of the poorly controlled patients was also highly significant and could be attributed to a nonstringent use of clinical guidelines. Among the other differences between well-controlled and poorly controlled patients, we found that well-controlled patients presented with lower levels of cholesterol and triglycerides, a lower prevalence of excess weight/obesity, and a greater prevalence of cardiovascular and/or cerebrovascular disease despite having a greater percentage of patients on antiplatelet therapy. Better application of therapeutic guidelines and the prevention and treatment of compounding factors could improve the response rate to BP control measures in poorly controlled patients.

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References

  1. Reaven GM . Banting lecture 1988: role of insulin resistance in human disease. Diabetes 1988; 37: 1595–1607.

    Article  CAS  Google Scholar 

  2. Hypertension in Diabetes Study (HDS): I. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. J Hypertens 1993; 11: 309–317.

  3. Kannel WB, McGee DL . Diabetes and cardiovascular risk factors: the Framingham study. Circulation 1979; 59: 8–13.

    Article  CAS  Google Scholar 

  4. Mitchell BD, Stern MP, Haffner SM, Hazuda HP, Patterson JK . Risk factors for cardiovascular mortality in Mexican Americans and non-Hispanic whites. San Antonio Heart Study. Am J Epidemiol 1990; 131: 423–433.

    Article  CAS  Google Scholar 

  5. Krolewski AS, Warran JH, Cupples A . Hypertension, orthostatic hypotension and microvascular complications of diabetes. J Chronic Dis 1985; 38: 319–326.

    Article  CAS  Google Scholar 

  6. Stamler J, Vaccaro O, Neaton JD, Wentworth D . Diabetes, other risk factors, and 12 year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993; 16: 434–444.

    Article  CAS  Google Scholar 

  7. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M . Mortality from coronary heart disease in subjects with type 2 diabetes and in non-diabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229–234.

    Article  CAS  Google Scholar 

  8. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351: 1755–1762.

    Article  CAS  Google Scholar 

  9. Birkenhager WH, Staessen JA, Gasowski J, de Leeuw PW . Effects of antihypertensive treatment on endpoints in the diabetic patients randomised in the systolic hypertension in Europe (Syst-Eur) trial. J Nephrol 2000; 13: 232–237.

    CAS  PubMed  Google Scholar 

  10. Parving HH . Diabetic hypertensive patients. Is this a group in need of particular care and attention? Diabetes Care 1999; 22 (Suppl 2): B76–B79.

    PubMed  Google Scholar 

  11. De Pablos PL, Martinez J, Martinez MP, Doreste JA . Prevalence of micro- and macroalbuminuria in a Canarian population of type 2 diabetic patients. Relationship with blood pressure, lipid profile, obesity and metabolic control. Diabetes Metab 1998; 24: 337–343.

    CAS  PubMed  Google Scholar 

  12. Llisterri Caro JL, Rodriguez Roca GC, Alonso Moreno FJ, Lou Arnal S, Divison Garrote JA, Santos Rodriguez JA et al. Grupo de Trabajo de Hipertension Arterial de la Sociedad Espanola de Medicina Rural y Generalista (Grupo HTA/SEMERGEN); Investigadores del Estudio PRESCAP 2002. Blood pressure control in Spanish hypertensive patients in Primary Health Care Centres. PRESCAP 2002 Study. Med Clin (Barc) 2004; 122: 165–171.

    Article  Google Scholar 

  13. Alvarez-Sala LA, Suarez C, Mantilla T, Franch J, Ruilope LM, Banegas JR, et al., Grupo PREVENCAT. PREVENCAT study: control of cardiovascular risk in primary care. Med Clin 2005; 124: 406–410.

    Article  Google Scholar 

  14. Banegas JR, Segura J, Ruilope LM, Luque M, Garcia-Robles R, Campo C, et al., CLUE Study Group Investigators. Blood pressure control and physician management of hypertension in hospital hypertension units in Spain. Hypertension 2004; 43: 1338–1344.

    Article  CAS  Google Scholar 

  15. European Society of Hypertension – European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

    Article  Google Scholar 

  16. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL 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 Program Coordinating 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: 2560–2572.

    Article  CAS  Google Scholar 

  17. Alberti KG, Zimmet PZ . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabet Med 1998; 15: 539–541; World Health Organization (1994). Prevention of diabetes mellitus: report of a WHO study group. World Health Organization: Geneva. Second report of the WHO expert committee on diabetes mellitus (Tech Rep Ser, # 844).

    Article  CAS  Google Scholar 

  18. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.

    Article  Google Scholar 

  19. Franklin SS, Gustin IV W, Wong ND, Larson MG, Weber MA, Kannel WB et al. Haemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997; 96: 308–311.

    Article  CAS  Google Scholar 

  20. de Pablos-Velasco P, Martinez-Martin FJ, Rodriguez Perez F, Urioste LM, Garcia Robles R . Prevalence, awareness, treatment and control of hypertension in a Canarian population. Relationship with glucose tolerance categories. The Guia Study. J Hypertens 2002; 20: 1965–1971.

    Article  CAS  Google Scholar 

  21. Schurgin S, Rich S, Mazzone T . Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care 2001; 24: 335–338.

    Article  CAS  Google Scholar 

  22. Millar JA, Lever AF, Burke V . Pulse pressure as a risk factor for cardiovascular events in the MRC Mild Hypertension Trial. J Hypertens 1999; 17: 1065–1072.

    Article  CAS  Google Scholar 

  23. Franklin SS, Khan SA, Wong ND, Larson MG, Levy D . Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study. Circulation 1999; 100: 354–360.

    Article  CAS  Google Scholar 

  24. Knudsen ST, Poulsen PL, Hansen KW, Ebbehoj E, Bek T, Mogensen CE . Pulse pressure and diurnal blood pressure variation: association with micro- and macrovascular complications in type 2 diabetes. Am J Hypertens 2002; 15: 244–250.

    Article  Google Scholar 

  25. Garcia Vallejo O, Vicente Lozano J, Vegazo O, Jimenez Jimenez FJ, Llisterri Caro JL, Redon J . Estudio DIAPA Control of blood pressure in diabetic patients in primary care setting. DIAPA study. Med Clin (Barc) 2003; 120: 529–534.

    Article  Google Scholar 

  26. Pellegrini F, Belfiglio M, De Berardis G, Franciosi M, Di Nardo B, Greenfield S, et al., 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: 473–480.

    Article  Google Scholar 

  27. Charpentier G, Genes N, Vaur L, Clerson P, Amar J, Gueret P et al. Arterial hypertension management in patients with type 2 diabetes. Arch Mal Coeur Vaiss 2002; 95: 661–665.

    CAS  PubMed  Google Scholar 

  28. Kemp TM, Barr EL, Zimmet PZ, Cameron AJ, Welborn TA, Colagiuri S et al. Glucose, lipid, and blood pressure control in Australian adults with type 2 diabetes: the 1999–2000 AusDiab. Diabetes Care 2005; 28: 1490–1492.

    Article  Google Scholar 

  29. Marques-Vidal P, Evans AE, Cambou JP, Arveiler D, Luc G, Bingham A et al. Awareness and control of hypertension and hypercholesterolaemia in France and Northern Ireland. QJM 1997; 90: 341–345.

    Article  CAS  Google Scholar 

  30. Green MS, Peled I . Prevalence and control of hypertension in a large cohort of occupationally active Israelis examined during 1985–1987: the Cordis Study. Int J Epidemiol 1992; 21: 676–682.

    Article  CAS  Google Scholar 

  31. Menotti A, Lanti M, Zanchetti A, Puddu PE, Cirillo M, Mancini M et al. Impact of the Gubbio population study on community control of blood pressure and hypertension. Gubbio Study Research Group. J Hypertens 2001; 19: 843–850.

    Article  CAS  Google Scholar 

  32. Gasse C, Hense HW, Stieber J, Doring A, Liese AD, Keil U . Assessing hypertension management in the community: trends of prevalence, detection, treatment, and control of hypertension in the MONICA Project, Augsburg 1984–1995. J Hum Hypertens 2001; 15: 27–36.

    Article  CAS  Google Scholar 

  33. Curb JD, Pressel SL, Cutler JA, Savage PJ, Applegate WB, Black H et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated hypertension. J Am Med Assoc 1996; 276: 1886–1892.

    Article  CAS  Google Scholar 

  34. Tuomilehto J, Rastenyte D, Birkenhager WH, Thijs L, Antikainen R, Bulpitt CJ et al. For the Systolic Hypertension in Europe Trial Investigators. Effects of calcium channel blockers in older patients with diabetes and systolic hypertension. N Engl J Med 1999; 340: 677–684.

    Article  CAS  Google Scholar 

  35. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317: 713–720.

    Article  Google Scholar 

  36. 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: 253–259.

    Article  Google Scholar 

  37. Parving H-H, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P . The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870–878.

    Article  CAS  Google Scholar 

  38. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving H-H et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861–869.

    Article  CAS  Google Scholar 

  39. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851–860.

    Article  CAS  Google Scholar 

  40. Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet 2000; 356: 1955–1964.

    Article  Google Scholar 

  41. Lindholm LH, Ibsen H, Dahlof B, Devereux RB, Beevers DG, de Faire U et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 1004–1010.

    Article  CAS  Google Scholar 

  42. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes. Lancet 2000; 355: 253–259.

    Article  Google Scholar 

  43. Eurich DT, Majumdar SR, Tsuyuki RT, Johnson JA . Reduced mortality associated with the use of ACE inhibitors in patients with type 2 diabetes. Diabetes Care 2004; 27: 1330–1334.

    Article  CAS  Google Scholar 

  44. Ruggenenti P, Fassi A, Ilieva AP, Bruno S, Iliev IP, Brusegan V et al. Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004; 351: 1941–1951.

    Article  CAS  Google Scholar 

  45. Whelton PK, Barzilay J, Cushman WC, Davis BR, Liamathi E, Kostis JB, et al., ALLHAT Collaborative Research Group. Clinical outcomes in antihypertensive treatment of type 2 diabetes, impaired fasting glucose concentration, and normoglycemia: antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 2005; 27: 165: 1401–1409.

    Google Scholar 

  46. Mancia G, Volpe R, Boros S, Ilardi M, Giannattasio C . Cardiovascular risk profile and blood pressure control in Italian hypertensive patients under specialist care. J Hypertens 2004; 22: 51–57.

    Article  CAS  Google Scholar 

  47. Hyman DJ, Pavlik VN . Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345: 479–486.

    Article  CAS  Google Scholar 

  48. Mitch WE . Treating diabetic nephropathy – are there only economic issues? N Engl J Med 2004; 351: 1934.

    Article  CAS  Google Scholar 

  49. Addler AL, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 321: 412–429.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology, Hospital General de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain

    P de Pablos-Velasco

  2. Department of Endocrinology, Hospital Ramón y Cajal, Madrid, Spain

    O Gonzalez-Albarran

  3. Department of Endocrinology, Hospital Obispo Polanco, Teruel, Spain

    V Estopiñan

  4. Department of Medicine, Abbott Laboratories, Madrid, Spain

    A Khanbhai

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  1. P de Pablos-Velasco
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  2. O Gonzalez-Albarran
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  3. V Estopiñan
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  4. A Khanbhai
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in representation of the TARMIDAS Group

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Correspondence to P de Pablos-Velasco or A Khanbhai.

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de Pablos-Velasco, P., Gonzalez-Albarran, O., Estopiñan, V. et al. Blood pressure, antihypertensive treatment and factors associated with good blood pressure control in hypertensive diabetics: the Tarmidas study. J Hum Hypertens 21, 664–672 (2007). https://doi.org/10.1038/sj.jhh.1002214

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