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American
Society of Hypertension updates guidelines
to address 7-Fold Mortality Increase in
Hypertensive Patients with Diabetes
Newswise — Updated guidance published in the
current issue of the American Society of
Hypertension's (ASH) Journal of Clinical
Hypertension addresses the urgent need for
physicians to take a more integrated,
individualized approach to treating
hypertension (high blood pressure) in
patients with diabetes by treating the
intricacies of each patient profile, rather
than focusing on the disease in isolation.
Early initiation of medications that block
the renin angiotension system (ACE
inhibitors or ARBs) coupled with either
thiazide-like diuretics or calcium
antagonists are needed to maintain BP
<130/80 mmHg.
Additionally, more frequent patient
follow-up is recommended.
While the fundamentals of treatment and
blood pressure goals remain unchanged, the
authors emphasize that early detection of
risk factors unique to each patient and
earlier, more aggressive treatment be
implemented.
Follow-up
visits after each medication adjustment
should occur within 2-3 weeks as opposed to
4-8 weeks, and immediate referral to an
ASH-certified clinical hypertension
specialist should occur if repeated attempts
to achieve blood pressure goal fails.
Achieving and sustaining blood pressure goal
earlier during treatment has been shown
retrospectively in many clinical trials to
have an impact on stroke risk.
Thus, such an approach is necessary to stop
the cardiovascular event rates and stroke
death toll from spiraling even further out
of control.
Hypertension affects more than 70 million
Americans and is the most prevalent risk
factor for cardiovascular and kidney
disease. More than 75% of adults with
diabetes have hypertension or are using
antihypertensive medications.
If implemented, this new guidance will
potentially lead to better control of blood
pressure, blood sugar and blood fats, all
major risk factors for cardiovascular events
if they are not properly managed.
"We know that mortality increases by more
than 7-fold when hypertension is present in
patients with diabetes," said George Bakris,
MD, president-elect of the American Society
of Hypertension, co-author of the Position
Paper and professor, University of Chicago
School of Medicine.
"Because of their increased cardiovascular
risk, these patients require an integrated
therapeutic intervention that, in addition
to blood pressure control, should include
glycemic and lipid control and antiplatelet
therapy.
"It
is imperative that we attack all risk
factors simultaneously and manage the
profile of each patient type more
vigilantly."
The guidance from the American Society of
Hypertension is offered in a series of
recommendations, accompanied by a modified
treatment algorithm.
Of note, the guidance draws attention to the
fact that treatment of blood pressure in
people with diabetes must also focus on
reducing proteinuria if present.
Proteinuria refers to an excessive amount of
protein in the urine and may be a sign of
impending kidney failure and/or a precursor
to stroke and other potentially
life-threatening cardiovascular events.
The guidance emphasizes the importance of
early identification and management of
proteinuria as part of its more integrative
approach to patient management.
"Diabetes is a complex disease in which
blood pressure control is imperative, but it
requires more than blood pressure control
alone to be most effective," explained Henry
Black, MD, president of the American Society
of Hypertension.
"Our medical organization is providing
physicians with more up-to-date guidance on
how to assess and treat hypertensive
patients with diabetes and we are saying
'act globally' to improve cardiovascular
health."
Current guidelines advise that patients
start on a combination antihypertensive
therapy, ideally in a single pill to improve
patient adherence, if blood pressure is
greater than 20/10 mmHg above recommended
target levels. ASH's new guidance reinforces
this concept and provides specific data
demonstrating how to initiate treatment and
follow up with patients to achieve target
blood pressure goals.
About the American
Society of Hypertension
The American Society of Hypertension (ASH)
is the largest U.S. organization devoted
exclusively to hypertension and related
cardiovascular diseases.
ASH is committed to alerting physicians,
allied health professionals and the public
about new medical options, facts, research
findings and treatment choices designed to
reduce the risk of cardiovascular disease.
For more information, please visit
http://www.ash-us.org.
The authors of The Journal of Clinical
Hypertension Position Paper were George L.
Bakris, MD and James R. Sowers, MD, on
behalf of the Hypertension Writing Group.
About The Journal of
Clinical Hypertension
The Journal of Clinical Hypertension (JCH),
published by Wiley-Blackwell provides
unbiased, peer-reviewed, clinically relevant
information to a wide audience of practicing
physicians treating hypertension and
cardiovascular disease.
It is distributed monthly to approximately
40,000 physicians in the United States,
including cardiologists, family
practitioners and internists, with the
primary objective of bridging the
“knowledge-practice gap” between researchers
and practicing clinicians.
The
Journal of Clinical Hypertension became an
official journal of the American Society of
Hypertension in 2005 and is listed in the
National Library of Medicine’s Index Medicus.
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