Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Commentary
  • Published:

Blood pressure control in the setting of diabetes mellitus: new targets, new hope for improvement?

Journal of Human Hypertension volume 20, pages 635–637 (2006)Cite this article

The prevalence of hypertension in the setting of diabetes mellitus (DM) is high and the coexistence of the two conditions together is particularly unfavourable, as both the conditions are significant risk factors for vascular disease.1 The importance of optimal blood pressure (BP) and DM control is gaining further momentum lately, and the possibilities of additional improvements in the care of these patients are being explored worldwide.2, 3 More recently, the question of whether enough attention was being given to BP measurements in DM clinics has been evaluated.4 The results provide more insight into missed opportunities for aggressive BP management on a background of DM.

The national diabetes audit suggested that a quarter of people with DM in the UK remain undiagnosed.3 Hypertension, like DM is also becoming a major global health crisis,2 demanding a vast proportion of health care resources directly and indirectly. The problem of hypertension in the setting of DM in the UK is large – a cross-sectional survey of over 250 000 patients from general practices across the UK recently reported that 56.2% of pharmacologically treated and 47.2% of diet-treated patients with DM had hypertension, as compared to 10.3% in those without DM.5 This was consistent with earlier reports, where the association between DM and hypertension was established in up to 65% of patients with DM, having major implications for cardiovascular disease (CVD) risk.6, 7

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42 (6): 1206–1252.

    Article  CAS  Google Scholar 

  2. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J . Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217–223.

    Article  Google Scholar 

  3. Mayor S . Quarter of people with diabetes in England are undiagnosed. BMJ 2005; 331 (7518): 656.

    PubMed  PubMed Central  Google Scholar 

  4. Wood JR, O'Riordan MA, Vogt BA, Palmert MR . Blood pressure measurement in diabetes clinic: are we paying enough attention? Diabetes Care 2006; 29 (3): 743–744.

    Article  Google Scholar 

  5. Hippisley-Cox J, Pringle M . Prevalence, care and outcomes for patients with diet-controlled diabetes in general practice: cross-sectional survey. Lancet 2004; 363: 423–428.

    Article  Google Scholar 

  6. Contreras F, Rivera M, Vasquez J, De la Parte MA, Velasco M . Diabetes and hypertension physiopathology and therapeutics. J Hum Hypertens 2000; 14: S26–S31.

    Article  Google Scholar 

  7. Jonas M, Reicher-Reiss H, Boyko V, Behar S, Grossman E . Hospital and 1-year outcome after acute myocardial infarction in patients with diabetes mellitus and hypertension. J Hum Hypertens 2003; 17: 665–670.

    Article  CAS  Google Scholar 

  8. Czupryniak L, Saryusz-Wolska M, Pawlowski M, Loba J . Elevated systolic blood pressure is present in almost all individuals with newly diagnosed diabetes. J Hum Hypertens 2006; 20: 231–233.

    Article  CAS  Google Scholar 

  9. Wild S, Roglic G, Green A, Sicree R, King H . Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diab Care 2004; 27 (5): 1047–1053.

    Article  Google Scholar 

  10. Campbell SM, Roland MO, Middleton E, Reeves D . Improvements in quality of clinical care in English general practice 1998–2003: longitudinal observational study. BMJ 2005; 331: 1121–1123.

    Article  Google Scholar 

  11. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF et al. British hypertension society. Guidelines for management of hypertension: report of the fourth working party of the british hypertension society, 2004-BHS IV. J Hum Hypertens 2004; 18 (3): 139–185.

    Article  CAS  Google Scholar 

  12. Mayor S . NICE calls for wider use of statins. BMJ 2006; 332: 256.

    Article  Google Scholar 

  13. Varughese GI, Patel JV, Lip GY, Varma C . Novel concepts of statin therapy for cardiovascular risk reduction in hypertension. Curr Pharm Des 2006; (11): (in Press).

  14. Varughese GI, Lip GY . Antihypertensive therapy in diabetes mellitus: insights from ALLHAT and the Blood Pressure-Lowering Treatment Trialists' Collaboration meta-analysis. J Hum Hypertens 2005; 19 (11): 851–853.

    Article  CAS  Google Scholar 

  15. Karalliedde J, Viberti G . Evidence for renoprotection by blockade of the renin-angiotensin-aldosterone system in hypertension and diabetes. J Hum Hypertens 2006 20 (4): 239–253.

    Article  CAS  Google Scholar 

  16. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–713.

    Article  Google Scholar 

  17. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S et al. HOT Study Group. Effects of intensive blood pressure-lowering and low-dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomized trial. Lancet 1998; 351: 1755–1762.

    Article  CAS  Google Scholar 

  18. He FJ, MacGregor GA . Cost of poor pressure control in the UK: 62000 unnecessary deaths per year. J Human Hypertens 2003; 17: 455–457.

    Article  CAS  Google Scholar 

  19. Williams R, Van Gaal L, Lucioni C . Assessing the impact of complications on the costs of Type II diabetes. Diabetologia 2002; 45: S13–S17.

    Article  Google Scholar 

  20. Gulliford MC, Charlton J, Latinovic R . Trends in antihypertensive and lipid-lowering therapy in subjects with type II diabetes: clinical effectiveness or clinical discretion? J Hum Hypertens 2005; 19 (2): 111–117.

    Article  CAS  Google Scholar 

  21. Stehouwer CD, Gall MA, Twisk JW, Knudsen E, Emeis JJ, Parving HH . Increased urine albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes: progressive, inter-related, and independently associated with the risk of death. Diabetes 2002; 51: 1157–1165.

    Article  CAS  Google Scholar 

  22. Varughese GI, Lip GY . Hypertension in patients with type-II diabetes: relation to urinary albumin excretion, endothelial function and inflammation. J Hum Hypertens 2005; 19 (6): 421–424.

    Article  CAS  Google Scholar 

  23. MacFadyen RJ, Lim HS . Emergence of structural arterial stiffness in diabetes and the role of abnormalities of autonomic tone in the sequence of events. J Hum Hypertens 2004; 18 (11): 755–756.

    Article  CAS  Google Scholar 

  24. Boero R, Prodi E, Elia F, Porta L, Martelli S, Ferraro L et al. How well are hypertension and albuminuria treated in type II diabetic patients? J Hum Hypertens 2003; 17: 413–418.

    Article  CAS  Google Scholar 

  25. Steinbrook R . Facing the diabetic epidemic – mandatory reporting of glycosylated hemoglobin values in New York city. N Engl J Med 2006; 354: 545–548.

    Article  CAS  Google Scholar 

  26. Kenny C . Diabetes and the quality and outcomes framework. BMJ 2005; 331: 1097–1098.

    Article  Google Scholar 

  27. Roland M . Linking physicians pay to quality of care – a major experiment in the UK. N Engl J Med 2004; 351: 1448–1454.

    Article  CAS  Google Scholar 

  28. Sutton M, McLean G . Determinants of primary medical care quality measured under the new UK contract: cross sectional study. BMJ 2006; 332: 389–390.

    Article  Google Scholar 

  29. Keen H . Diabetes and the quality and outcomes framework: diabetes needs reintegration of primary and secondary care. BMJ 2005; 331 (7528): 1340.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Department of Medicine, City Hospital, Birmingham, UK

    G I Varughese, J V Patel & G Y H Lip

Authors
  1. G I Varughese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J V Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G Y H Lip
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G Y H Lip.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Varughese, G., Patel, J. & Lip, G. Blood pressure control in the setting of diabetes mellitus: new targets, new hope for improvement?. J Hum Hypertens 20, 635–637 (2006). https://doi.org/10.1038/sj.jhh.1002029

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1002029

This article is cited by

Search

Advanced search

Quick links