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Blood pressure control in Japanese hypertensives with or without type 2 diabetes mellitus
S Katayama1, M Inaba, T Morita
1Fourth Department of Medicine, Saitama Medical School, Iruma-gun, Japan.
Insights
Blood pressure control is insufficient in Japanese patients with hypertension, including those with type 2 diabetes. Less than 130/85 mmHg was achieved in only 10% of patients, highlighting a need for improved hypertension management in high-risk groups.
Area of Science:
- Cardiology
- Endocrinology
- Hypertension Research
Background:
- Type 2 diabetes mellitus and hypertension significantly increase cardiovascular disease risk.
- Current hypertension guidelines recommend target blood pressure below 130/85 mmHg.
Purpose of the Study:
- To assess blood pressure control in Japanese hypertensive patients with and without type 2 diabetes mellitus.
- To understand antihypertensive medication prescribing patterns in these patient groups.
Main Methods:
- Survey of 200 physicians from the Japanese Society of Hypertension and Japanese Diabetes Society.
- Data collected on 954 hypertensive patients with type 2 diabetes and 371 without.
- Analysis of achieved blood pressure and number/type of antihypertensive agents used.
Main Results:
- Achieved blood pressure below 140/90 mmHg was 40.5% in non-diabetics and 38.3% in diabetics.
- Only 10.8% of non-diabetics and 11.4% of diabetics reached blood pressure below 130/85 mmHg.
- Physicians used more ACE inhibitors and alpha-blockers in diabetics, while Ca-antagonists were common in both groups.
Conclusions:
- Despite considering metabolic effects, blood pressure control remains inadequate in Japanese hypertensive patients, including those with diabetes.
- A significant gap exists in achieving target blood pressure levels, necessitating improved hypertension management strategies.
- Enhanced blood pressure control is crucial for high-risk populations like diabetic hypertensive patients to reduce cardiovascular events.
Abstract:
Patients with type 2 diabetes mellitus and hypertension are thought to be at high risk for cardiovascular diseases. Recent guidelines for treatment of hypertension such as the JNC VI and WHO/ISH guidelines, recommend that antihypertensive agents be strated at as low as at 130/85 mmHg and that blood pressure be lowered to less than 130/85 mmHg. Our study was designed to clarify how well and to what extent blood pressure (BP) was controlled in Japanese hypertensive patients with or without type 2 diabetes mellitus. We interviewed two hundred physicians, randomly sellected from among the members of the Japanese Society of Hypertension (JSH) (n=98) and the Japanese Diabetes Society (JDS) (n=102) and obtained information regarding five most recent cases of hypertension with (n=954 in total) and their 2 most recent cases of hypertension without diabetes (n=371 in total). The achieved BP was below 140/90 mmHg in 40.5% of non-diabetic and 38.3% of diabetic hypertensives. The percentage of patients whose BP was less than 130/85 mmHg was 10.8% in nondiabetics and 11.4% in diabetics. The average number of hypotensive agents used was 1.46 in nondiabetics and 1.52 in diabetics. Physicians prescribed more ACE inhibitors and alpha-blockers in diabetics than in nondiabetics, although Ca-antagonists were administered in more than 70% of patients irrespective of whether or not they had diabetes. In contrast, fewer beta-blockers and diuretics were administered to diabetics. These results suggest that although Japanese physicians are considering the effects of hypotensive agents on metabolism and renal function when they treat diabetic hypertensives, the achieved blood pressure in both hypertensives with and those without diabetes is insufficient, with only one of ten patients having a blood pressure less than 130/85 mmHg even among diabetics. Improved blood pressure control will therefore be needed to treat high risk groups such as patients with diabetes mellitus.