Antihypertensive Treatment and Macrovascular Complications in Type 2 Diabetes - Results of Large Clinical Trials

Abstract

Diabetes mellitus doubles the risk of cardiovascular disease. Hypertension is present in 80% of type 2 diabetic patients and substantialy accounts for increased cardiovascular morbidity and mortality. Benefits of blood pressure reduction and influence of different antihypertensive treatment on the frequency of macrovascular diabetes complications had remained uncertain until results of large clinical trials have been published. Trials UKPDS, SHEP, Syst-Eur and HOT have shown that reduction of blood pressure in type 2 diabetes significantly reduces incidence of macrovascular complications, and effects are the greater the lower blood pressure values are achived. Clinical benefits of blood pressure lowering are more evident in hypertensive diabetics than in hypertensive subjects without diabetes but to achive proper antihypertensive effect three drugs therapy usually needed. Comparative trials UKPDS, CAPPP, ABCD, FACET and HOPE have revealed that ACE inhibitors, given to hypertensive type 2 diabetics may provide special advantage to prevent macrovascular complications in addition to blood pressure control. For that reason ACE inhibitors seem to be superior to other antihypertensive agents in this group of patients. According to LIFE trial the similar beneficial effect of blockade of angiotensin II with selective angiotensin II receptor antagonist can be assumed.