PHILADELPHIA — Lowering blood pressure might be more effective than lowering blood sugar alone for reducing the risk of cardiovascular events in type 2 diabetes patients, according to Dr. George J. Philippides, director of the coronary care unit at Boston Medical Center.
Reducing blood pressure in patients with type 2 diabetes can result in “profound” reductions in the risk of cardiovascular events, Dr. Philippides said at Endocrinology in the News sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS.
For example, in the U.K. Prospective Diabetes Study, patients who achieved tight control of their blood pressure (mean blood pressure of 144/82 mm Hg) lowered their risk of stroke by 44%, compared with the group of patients with a mean blood pressure of 154/87 mm Hg. The group with tight blood pressure control also had a 34% risk reduction for macrovascular diseases, compared with the group with less tight control (BMJ 1998;317:703-13).
By comparison, the evidence is less clear about whether achieving tight glycemic control alone will lower the risk of cardiovascular events, Dr. Philippides said. Physicians should lower sugar levels for other reasons, such as the microvascular benefits, but the evidence so far fails to show that doing so lowers the risk for myocardial infarction, he said.
Dr. Philippides advised physicians to be aggressive in treating hypertension in diabetes patients because of the significant benefits seen with even small decreases in blood pressure. For many patients, that might mean using three agents, he said.
Dr. Philippides is on the speakers bureau for Bristol-Myers Squibb Co., is a consultant for Merck & Co., and receives research support from Sanofi Aventis.