Doctors Urged to Set Lower Blood-Pressure Goals for Diabetics
Doctors Urged to Set Lower Blood-Pressure Goals for Diabetics
Current guidelines suggest that doctors strive for a blood-pressure reading lower than 130/85 in diabetics. But according to the Kidney Foundation's new recommendations, which appear in the September issue of the American Journal of Kidney Diseases, blood pressure should be no higher than 130/80 in these patients.
"Inadequately treated high blood pressure is a serious condition that can lead to kidney failure and premature death," the foundation's president-elect, William Keane, MD, says in a prepared statement sent to WebMD.
The foundation notes that aggressive treatment that lowers diastolic pressure -- the lower number in the blood-pressure reading -- to about 80 has been linked to lower risks of cardiovascular and kidney problems. Diabetes makes patients more vulnerable to heart attacks and kidney failure, and high blood pressure just adds to the health risks.
High blood pressure in a diabetic "is like adding gasoline to the fire," says George Bakris, MD, who led the National Kidney Foundation committee that created the recommendations.
But the American Diabetes Association (ADA) is not ready to jump on the aggressive-treatment bandwagon just yet. Despite the foundation's new recommendation, the ADA is standing by the higher blood-pressure threshold, which it believes is not only safe but more achievable, says Richard Kahn, PhD, the ADA's chief scientific and medical officer.
Last week, WebMD reported that Bakris had offered a sneak preview of the new guidelines during a press briefing on hypertension. At that event, Bakris noted that doctors need to "go for the blood pressure" when they are not certain what to treat first in diabetics who also have high blood pressure. Lowering the blood pressure will buy time for these patients to get their blood sugar under control, he said.
"Data from several major recent clinical trials demonstrate that patients require an average of more than three different ... medications to reach lower blood-pressure goals," Bakris notes in the foundation's statement. "Physicians must be willing to shift to more-flexible [drug] treatment strategies if we are to achieve the recommended blood-pressure goals that will further reduce the high [sickness and death] rates attributable to diabetes and hypertension in the United States."
The group recommends that diabetics with high blood pressure first be treated with a type of drug known as ACE inhibitors, with the dosage increased as needed while the patients are monitored for side-effects. If blood pressure does not drop into the recommended range, they suggest adding a diuretic or another type of drug called calcium channel blocker.
The Kidney Foundation's report was funded in part by Novartis Pharmaceuticals Corp., which makes blood pressure medications, including ACE inhibitors.
Doctors Urged to Set Lower Blood-Pressure Goals for Diabetics
Current guidelines suggest that doctors strive for a blood-pressure reading lower than 130/85 in diabetics. But according to the Kidney Foundation's new recommendations, which appear in the September issue of the American Journal of Kidney Diseases, blood pressure should be no higher than 130/80 in these patients.
"Inadequately treated high blood pressure is a serious condition that can lead to kidney failure and premature death," the foundation's president-elect, William Keane, MD, says in a prepared statement sent to WebMD.
The foundation notes that aggressive treatment that lowers diastolic pressure -- the lower number in the blood-pressure reading -- to about 80 has been linked to lower risks of cardiovascular and kidney problems. Diabetes makes patients more vulnerable to heart attacks and kidney failure, and high blood pressure just adds to the health risks.
High blood pressure in a diabetic "is like adding gasoline to the fire," says George Bakris, MD, who led the National Kidney Foundation committee that created the recommendations.
But the American Diabetes Association (ADA) is not ready to jump on the aggressive-treatment bandwagon just yet. Despite the foundation's new recommendation, the ADA is standing by the higher blood-pressure threshold, which it believes is not only safe but more achievable, says Richard Kahn, PhD, the ADA's chief scientific and medical officer.
Last week, WebMD reported that Bakris had offered a sneak preview of the new guidelines during a press briefing on hypertension. At that event, Bakris noted that doctors need to "go for the blood pressure" when they are not certain what to treat first in diabetics who also have high blood pressure. Lowering the blood pressure will buy time for these patients to get their blood sugar under control, he said.
"Data from several major recent clinical trials demonstrate that patients require an average of more than three different ... medications to reach lower blood-pressure goals," Bakris notes in the foundation's statement. "Physicians must be willing to shift to more-flexible [drug] treatment strategies if we are to achieve the recommended blood-pressure goals that will further reduce the high [sickness and death] rates attributable to diabetes and hypertension in the United States."
The group recommends that diabetics with high blood pressure first be treated with a type of drug known as ACE inhibitors, with the dosage increased as needed while the patients are monitored for side-effects. If blood pressure does not drop into the recommended range, they suggest adding a diuretic or another type of drug called calcium channel blocker.
The Kidney Foundation's report was funded in part by Novartis Pharmaceuticals Corp., which makes blood pressure medications, including ACE inhibitors.
