hypertension

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.