MADRID — Fasting blood glucose levels appear to be higher in diabetic patients with poorly controlled blood pressure than in those with well-controlled pressure, Dr. Miroslav Soucek said at the annual meeting of the European Society of Hypertension.
This observation was based on a survey of more than 2,200 patients from 150 primary care practices throughout the Czech Republic. The primary objective of the study was to determine the prevalence of hypertension in the Czech population, and the extent to which physicians there are able to help their patients achieve blood pressure control targets as outlined in current ESH guidelines, Dr. Soucek said in presenting the findings in a poster.
Each participating physician recorded thorough case data from 15 consecutive patients aged at least 45 years, irrespective of the reason for each patient's visit. The idea was to get a representative sampling of the health status of all patients seeking care in primary care offices. The investigators defined hypertension as blood pressures above 140/90 mm Hg.
The pressure measurements were taken from patients in the sitting position, and participants were instructed to take three separate measurements and average the values of the last two measurements. Dr. Soucek and his colleagues obtained data from 2,211 patients with a mean age of 62 years.
Of the entire cohort, 78% of the patients were defined as hypertensive; of the 403 patients with diabetes, 75% had hypertension. Only 18% of all patients being treated for hypertension were considered well controlled (pressures under 130/80 mm Hg); the rate for diabetics was 6%.
Blood pressure was uncontrolled in almost 30% of the diabetic patients with hypertension even though they were on at least three antihypertensive drugs, Dr. Soucek noted.
The most striking finding of this study—one that surprised the investigators themselves—was the correlation between poor pressure control and increased fasting blood glucose. “The average fasting blood glucose showed a gradual increase, with increasing blood pressure, from 7.98 mmol/L in diabetics with blood pressure under 130/80 mm Hg to 9.44 in diabetic patients with blood pressures greater than 180/110 mm Hg,” reported Dr. Soucek of the department of internal medicine, St. Anne University Hospital, Brno, Czech Republic.
The mechanism underlying this connection is not known, and it is too soon to tell if there is a causal connection, or if the elevated pressure and the increased blood glucose are co-occurring manifestations of a deeper metabolic dysregulation.
The clinical implication, however, is clear: Uncontrolled blood pressure in a diabetic patient may be a signal for uncontrolled glucose as well. These patients need even closer attention than nondiabetic hypertensives or diabetics who are not hypertensive, he said.
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