Page 60 - fbkCardioDiabetes

Fighting against the deadly duo mean systolic blood pressure was associated with
relative risk reduction of 12% for any complication
Introduction of diabetes, 15% for deaths related to diabetes, 11%
for myocardial infarction and 13% for microvascular
Diabetes mellitus is a heterogeneous chronic met-
abolic disease where both microvascular and mac- complications
rovascular complications contribute to morbidity and • The HOT (Hypertension Optimal Treatment study)
mortality. Cardiovascular diseases are the costliest showed that diabetics with high BP,will need 2-3
complications of diabetes andare rapidly increasing drugs to control their BP.
in prevalence in recent decades in developing coun- • The Systolic Hypertension in the Elderly Program
tries like India and have emerged as leading causes (SHEP) and other studies like Hypertension De-
1,2
of death. . Hypertension is a major risk factor for tection and Follow-up Program(HDFP), Systolic
cardiovascular and renal disease. Hypertension and Hypertension in Europe (Syst-Euro),HOT, normo-
diabetes mellitus (DM) frequently coexist. When hy- tensive Appropriate Blood pressure Control in Di-
pertension occurs in diabetes,it accelerates the pro- abetes(ABCD), and Heart Outcomes Prevention
gression of both microvascular and macrovascular Evaluation(HOPE) provide firm evidence that even
complications and the mortality increases by more small BP reductions translate to significant de-
than seven fold.
crease in both micro and macrovascular compli-
Hypertension is twice as prevalent in diabetics as in cations in persons with type 2 diabetes.
non-diabetic individuals. In patients with type 1 diabe-
tes mellitus, hypertension develops at the onset of • The ADVANCE (Action in Diabetes and Vascular
diabetic nephropathy while in type 2 diabetes melli- Disease; Preterax and Diamicron MR Controlled
tus, more than 50% patients are hypertensive at the Evaluation) study showed that intensive control
time of diagnosis. of BP resulted in reduction in composite micro
and macrovascular complications by 9%, coronary
The estimated number of people with hypertension events by 14% and renal events by 21%.
is increasing worldwide, andis expected to increase
from 972million in2000, to 1.56 billion by 2025. In • The Advance Collaborative Group study demon-
diabetes, estimated number of people worldwide is strating the benefit of an angiotensin - converting
expected to increase from 382 million in 2012 to 592 enzyme (ACE) inhibitor and indapamide in a fixed
billion in 2030 . Forty-eight percent of the anticipated combination, strongly suggesting that the blood
2
absolute global increase of 186 million people with di- pressure goal (<130/80 mmHg) was beneficial
abetes is projected to occur in India and China alone. • The ACCORD (Action to Control Cardiovascular
Risk in Diabetes) trial was unable to find a signifi-
EVIDENCE cant reduction in incidence of major CV events in
patients with diabetes whose SBP was lowered to
Studies related to hypertension and diabetic patients
worldwide 2,3 an average of 119mmHg compared with patients
whose SBP remained at an average of 133mmHg.
In the UKPDS study, each 10 mmHg decrease in

GCDC 2017

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