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Recommendation
| Note that it remains unclear whether hypertensive patients with diabetes without nephropathy should be treated with different antihypertensive agents than those without diabetes.
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Evidence:
- For diabetes patients without nephropathy, five studies have suggested that ACE inhibitors and angiotensin-receptor blocking agents may still provide better protection than other agents against cardiovascular events (100; 101; 102; 103) and death (103; 104) and that this effect is at least partly independent of BP reduction.
- However, three large studies have failed to confirm an added benefit of ACE inhibitors over calcium-channel blockers or β-blockers in both hypertensive (105; 106) and normotensive (92) patients with diabetes. ALLHAT, which was a 4- to 8-year study of high-risk hypertensive patients, including over 12,000 with diabetes, found that lisinopril treatment was equivalent to diuretic treatment (chlorthalidone) in preventing cardiovascular events (106). In addition, diuretic treatment was associated with lower 6-year rates of CVD, stroke, and heart failure when compared to lisinopril therapy. Finally, a large meta-analysis of predominantly nondiabetic persons did not find that ACE inhibitors provided cardiovascular benefit over other types of drugs (mostly diuretics and β-blockers) for hypertension treatment (107).
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Comments:
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| Denice S. Feig, MD, MSc, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lorraine Lipscombe, MD, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Sonal Singh, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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Screening for Type 2 Diabetes
> Effectiveness/Harms of Early Treatment
