New High Blood Pressure Study

New High Blood Pressure Study

NEW HIGH BLOOD PRESSURE
STUDY

One of the ramifications
of diabetes is nephropathy, diabetic kidney disease. It has been known for some
time that ACE (angiotensin-converting enzyme) Inhibitors, a class of blood pressure
medications, have been effective in reducing kidney disease in patients with
type 1 diabetes. It was assumed these medications would be equally effective
in cases of type 2 diabetes. A Los Angeles, California study of the efficacy
of different blood pressure reduction therapies has suggested otherwise.
Harry J. Ward, MD, Professor of Medicine
at UCLA, and his colleagues recently presented a paper to the American Society
of Hypertension, which showed that, for his study subjects (1100 inner-city
African-Americans, Hispanics, and poor Whites, 241 with type 2 diabetes, 40%
of them showing microalbuminuria or proteinuria) the fact of blood pressure
reduction is more important than the means. If you get the blood pressure down,
the study suggests, the rate of kidney disease will drop.
One hundred fifty five of the study's
diabetic patients had their hypertension treated with ACE inhibitors. Eighty-six
were treated with other medications, such as calcium channel blockers, alpha-blockers,
or diuretics.
Reasoning that patient compliance may
be as important as class of medication, Dr. Ward's study also compared the efficacy
of four different behavioral approaches:
* Traditional care, where patients merely
visited the doctor and received their prescription;
* Exit interviews, where patients received
individualized counseling sessions to reinforce their understanding of treatment
instructions;
* Computerized tracking, by which patients
received timely reminders to visit the clinic; and
* Home visits/focus groups, involving
visits by community workers to patients' homes to assess problems with patient
compliance, and to work with patients' families, spouses etc., to improve compliance.
What did they find? After four years
of follow-up, the investigators observed no significant difference in the rate
of diabetic kidney disease progression (how fast it got worse) between those
study participants treated with ACE inhibitors and those treated with other
therapies. They also found that the "biobehavioral" interventions
offered by the study significantly improved patient compliance, and were a major
component in the success of any one of the therapies.
Dr. Ward noted that although in type
1 diabetes ACE inhibitors have been demonstrated to be the best choice for kidney
protection, in type 2 the ACE inhibitors were not necessarily better than the
other anti-hypertensives tested. It appears that for type 2 diabetics who suffer
from hypertension and nephropathy, the need to get the blood pressure down is
more important than the class of medications used to do so.
Dr. Ward also noted there are still
unanswered questions, and that several more studies of type 2 diabetes and hypertension
are currently underway to answer them. Two studies he mentioned involve the
new angiotensin receptor antagonists (Losartan and Irbesartan). When they are
reported (in two or three years), we should have a much better idea which are
the best therapies for high blood pressure and type 2 diabetes.