How Best to Manage BP in Diabetics

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Data support the use of ACE inhibitors, angiotensin receptor blockers .
 
Two new studies may help define how best to treat hypertensive patients with diabetes.
 
In one study, researchers found that using a high dose of the angiotensin receptor block valsartan (Diovan) is more effective than a low dose of the drug at reducing microalbuminuria. After 30 weeks, 51% of those taking 320 mg daily achieved significant reductions in proteinuria compared with 26% of those taking 160 mg daily.

Normal protein excretion levels were achieved by 24% of those taking 640 mg a day compared with 12% of those using 160 mg a day, investigators reported at the American Heart Association Annual Scientific Sessions in Chicago. The highest approved daily dosage is 320 mg.
 
In addition, a BP less than 130/80 mg Hg—the goal for diabetics recommended by the latest hypertension guidelines in diabetics—was achieved in 75% of those taking valsartan 640 mg plus either amlodipine or hydrochlorothiazide, or all three agents. The most common side effects were headache and dizziness.

Guidelines state that two or more drugs are usually needed to achieve the target BP goal in diabetic hypertension, and they note that both ACE inhibitors and ARBs “favorably affect the progression of diabetic nephropathy and reduce albuminuria.”

In the other study, Italian researchers studied 1,204 diabetic hypertensive patients randomized to receive the ACE inhibitor trandolapril (Mavik) 2 mg/day or the calcium channel blocker verapamil
SR at a dosage of 24 mg/day.

At the end of the 3.6-year study, microalbuminuria was significantly less likely to develop in the trandolapril group than in the verapamil recipients, the investigators reported in the Journal of the American Society of Nephrology (2006; published online ahead of print). The verapamil-treated patients had  no reduced risk, regardless of how well their BP was controlled. Patients taking both drugs, however, achieved lower BP than those taking either one alone.

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