Target Values of Blood Pressure in Patients with Diabetes Mellitus

Authors: M. Souček
Authors‘ workplace: II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Miroslav Souček, CSc.
Published in: Vnitř Lék 2009; 55(4): 363-367


Diabetes mellitus considerably worsens the prognosis of hypertension both in the occurrence of microvascular and macro­vascular complications. The guidelines of the European Society of Hypertension and the European Society of Cardiology suggest a significantly more invasive treatment of hypertension achieving blood pressure target values below 130/80 mm Hg. The control of hypertension in diabetic patients treated with antihypertensives in the consulting rooms of our physicians is poor. Target values < 130/80 mm Hg are achieved in less than 5% of cases. More extensive application of combined treatment, in particular 3 or more antihypertensives, and improvement of patients’ adherence to the treatment could improve the current situation.

Key words:
hypertension – diabetes mellitus – hypertension control with diabetes – cardiovascular risk


1. Rathmann W, Giani G. Global prevalence of diabetes: estimates for the year 2000 and projection for 2030. Diabetes Care 2004; 27: 1047–1053.

2. Grundy SM, Benjamin IJ, Burke GL et al. Diabetes and cardiovascular disease: a statement for healthcare professional from the American Heart Association. Circulation 1999; 100: 1134–1346.

3. Wilson PW, D’Agostino RB, Levy D et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837–1847.

4. Simonson DC. Etiology and prevalence of hypertension in diabetic patients. Diabetes Care 1988; 11: 821–827.

5. Sowers JR, Farrow SL. Treatment of elderly hypertensive patients with diabetes, renal disease and coronary heart disease. Am J Geriatr Cardiol 1996; 5: 57–70.

6. Cífková R. Léčba hypertenze u pacientů s diabetem. Farmakoterapie 2008; 3: 303–308.

7. Mancia G, De Backer C, Dominiczak A et al. 2007 Guidelines for management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.

8. Widimský J jr, Cífková R, Špinar J et al. Doporučení diagnostických a léčebných postupů u arteriální hypertenze – verze 2007. Doporučení české společnosti pro hypertenzi. Cor Vasa 2008; 50: K5–K22.

9. Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension 1992; 19: 403–418.

10. Tarnow L, Rossing P, Gall MA et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabetes Care 1994; 17: 1247–1251.

11. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistence and the sympathoadrenal system. N Engl J Med 1996; 334: 374–381.

12. Grossmann E, Messerli FH. Diabetic and hypertensive heart disease. Ann Intern Med 1996; 125: 304–310.

13. Dinneen SF, Gerstein HC. The association of microalbuminuria and mortality in non‑insulin‑dependent diabetes mellitus. A systematic overview of the literature. Arch Intern Med 1997; 157: 1413–1418.

14. Teuscher A, Schnell H, Wilson PW. Incidence of diabetic retinopathy and relationship to baseline plasma glukose and blood pressure. Diabetes Care 1988; 11: 246–251.

15. Lewis EJ, Hunsicker LG, Bain RP et al. The effect of angiotensin‑converting‑enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 1993; 329: 1456–1462.

16. Chaturvedi N, Sjolie AK, Stephenson JM et al. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. The EUCLID Study Group. EURODIAB Controlled Trial of Lisinopril in Insulin‑Dependent Diabetes Mellitus. Lancet 1998; 351: 28–31.

17. Borch-Johnson K, Nissen R, Nerup J. Blood pressure after 40 years of insulin dependent diabetes. Nephron 1985; 4: 11–12.

18. Hannson L, Zanchetti A, Carruthers SG et al. Effect of intensive blood-pressure lowering and low‑dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351: 1755–1762.

19. Williams B. The pharmacological treatment of hypertension in diabetes. In: Williams B (ed). Hypertension in diabetes. London: Martin Dunitz 2003: 285–316.

20. Patel A, MacMahon S, Chalmers J et al. ADVANCE Collaborating Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and mikrovascular outcomes in patients type 2 diabetes mellitus (the ADVANCE trial): a randomised controled trial. Lancet 2007; 370: 829–840.

21. Dluhy RG, McMahon GT. Intensive glycemic control in the ACCORD and ADVANCE trials. N Engl J Med 2008; 358: 2630–2633.

22. Szabó M. Studie ADVANCE – větev intervence hyperglykémie. Remedia 2008; 4: 310–313.

23. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta‑analysis. Lancet 2007; 369: 201–207.

24. Kalita Z, Souček M, Sachová M. Výskyt rizikových faktorů cévní mozkové příhody v populaci České republiky. Průzkum STOP CMP. Prakt Lék 2003; 83: 643–646.

25. Widimský J, Souček M, Sachová M et al. Hypertenze a diabetes mellitus v ordinacích praktických lékařů. Výskyt hypertenze a její kon­trola. Cor Vasa 2005; 47: 127–132.

26. Souček M, Widimsky J, Lánská V. Control of hypertension in patients with hypertension, diabetes, and impaired fasting glucose by Czech primary care physicians. Kidney Blood Press Res 2006; 29: 366–372.

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