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- 2. Diabetes The leading cause of new cases of end stage renal disease A 2- to 4-fold increase in cardio- vascular mortality The leading cause of new cases of blindness in working-aged adults The leading cause of nontraumatic lower extremity amputations
- 3. 0 10 20 30 40 50 60 70 80 Tight (n=758) mean achieved BP 144/82 mmHg Less tight (n=390) mean achieved BP 154/87 Any diabetes-related endpoint Diabetes- related death Stroke Microvascular complications Eventsper1000patientyrs P=0.005 P=0.02 P=0.01 P=0.009 UKPDS Group. BMJ. 1998;317:703–713.
- 4. 1.0 0.9 0.8 0.7 0.6 0.5 0 1 2 3 4 5 6 Years Survival(all-causemortality) Normoalbuminuria (n=191) Microalbuminuria (n=86) Macroalbuminuria (n=51) P<0.01 normoalbuminuria vs. microalbuminuria P<0.001 normoalbuminuria vs. macroalbuminuria P<0.05 microalbuminuria vs. macroalbuminuria Gall MA, et al. Diabetes. 1995;44:1303-1309.
- 5. -P-H -P+H +P-H +P+H 0 500 1,000 Status of Protienuria (P) and Hypertension (H) in Type 2 Diabetics -P-H Men -P+H +P-H +P+H Women Wang SL, et al. Diabetes Care. 1996;19:305-312.
- 7. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 2003.
- 8. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 2003.
- 9. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. Williams, B. et al. BMJ 2004;328:634-640
- 10. TARGET <140/90 mmHg INITIAL TREATMENT AND MONOTHERAPY * BBs are not indicated as first line therapy for age 60 and above Beta- blocker* Long- acting CCB Thiazide ACE-I ARB Lifestyle modification therapy V. Treatment of Adults with Systolic/Diastolic Hypertension without Other Compelling Indications 2006 CANADIAN HYPERTENSION EDUCATION PROGRAM RECOMMENDATIONS. CHEP Recommendations for the Management of Hypertension January 28th 2006.
- 11. XII. Treatment of Hypertension in association with Diabetes Mellitus: More than 3 drugs may be needed to reach target values for diabetic patients If Creatinine over 150 µmol/L or creatinine clearance below 30 ml/min ( 0.5 ml/sec), a loop diuretic should be substituted for a thiazide diuretic if control of volume is desired Threshold equal or over 130/80 mmHg and TARGET below 130/80 mmHg Diabetes with Nephropathy Combination (Effective 2-drug combination) ACE Inhibitor or ARB without Nephropathy 1. ACE-Inhibitor or ARB or 2. Thiazide diuretic or DHP-CCB 2006 CANADIAN HYPERTENSION EDUCATION PROGRAM RECOMMENDATIONS. CHEP Recommendations for the Management of Hypertension January 28th 2006.