Blood pressure-lowering treatment could harm some patients with diabetes

[DCUK NewsBot]

People with diabetes who have systolic blood pressure levels under 140 mm Hg and are treated with blood pressure-lowering drugs could have an increased risk of dying from cardiovascular causes, research suggests. These findings were reported by at Umeå University, Sweden. People with diabetes are more likely to have higher blood pressure and keywordcardiovascular disease, so researchers Mattias Brunström and Bo Carlberg investigated how antihypertensive treatment affected diabetic patients with different blood pressure levels. The blood pressure targets set by NICE for people with diabetes vary slightly depending on diabetes type. People with type 1 diabetes should aim to keep their blood pressure below 135/85 mm Hg; people with type 2 diabetes should aim for below140/80 mm Hg, but this target drops to below 130/80 mm HG if you have diabetic nephropathy (kidney disease) or two signs of metabolic syndrome. The researchers collected data from 49 published and unpublished studies involving nearly 74,000 participants, most of whom had type 2 diabetes. They found that the effects of antihypertensive treatment depend on patients' blood pressure levels before treatment - specifically, systolic blood pressure. If a patient had systolic blood pressure higher than 140 mm Hg before beginning treatment, they experienced a decreased risk of death, stroke, heart attack and heart failure. However, these benefits did not apply to patients whose systolic blood pressure was below 140 mm Hg. These patients actually had a 15 per cent increased risk of cardiovascular death. Brunström clarified that because the majority of patients had type 2 diabetes, no conclusions can be made regarding people with type 1 diabetes or patients with diabetes and normal blood pressure levels. Brunström explained: "In practice, it is important to remember that undertreatment of high blood pressure is a bigger problem than overtreatment. At the same time, […] blood pressure-lowering treatment is crucial for the majority of people with diabetes whose blood pressure measures above 140. "Many treatment guidelines, both Swedish and international, will be redrawn in the next few years. It has been discussed to recommend even lower blood pressure levels for people with diabetes - maybe as low as 130. We are hoping that our study, which shows potential risks of such aggressive blood pressure lowering treatment, will come to influence these guidelines." The authors added that blood pressure treatment aims should be handled less aggressively among people with diabetes, and doctors should use caution when prescribing treatment. The study was published in the BMJ.

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[NoCrbs4Me]

I'm glad I didn't fill my doctor's prescription for blood pressure pills. I had normal blood pressure, but it is apparently supposed to be standard practice to prescribe blood pressure lowering meds to all type 2 diabetics "to protect the kidneys". However, I think most doctors ignore this.

 

[ann34+]

I'm glad I didn't fill my doctor's prescription for blood pressure pills. I had normal blood pressure, but it is apparently supposed to be standard practice to prescribe blood pressure lowering meds to all type 2 diabetics "to protect the kidneys". However, I think most doctors ignore this.

.... for Type ones a very small dose of ACE is often given 'to protect the kidneys' but i dont know about Type 2s

 

[NoCrbs4Me]

.... for Type ones a very small dose of ACE is often given 'to protect the kidneys' but i dont know about Type 2s

Same for type 2s, although most doctors don't do this. This study suggests that giving these meds to type 2s with normal blood pressure is a really bad idea, perhaps even for type 1s, although the study didn't make conclusions with respect to type 1.

 

[noblehead]

My systolic level was normal around 140 before starting on a bp drug called Ramipril, as I had diabetic retinopathy at the time it was suggested by my Ophtmalogist and gp that I should start on a low-dose bp med to get my bp levels below 130/70 as this is said to help patients who have retinopathy, as the article says '' undertreatment of high blood pressure is a bigger problem than overtreatment.''

 

[NoCrbs4Me]

My systolic level was normal around 140 before starting on a bp drug called Ramipril, as I had diabetic retinopathy at the time it was suggested by my Ophtmalogist and gp that I should start on a low-dose bp med to get my bp levels below 130/70 as this is said to help patients who have retinopathy, as the article says '' undertreatment of high blood pressure is a bigger problem than overtreatment.''

You were treated for normal blood pressure, not high blood pressure. From the study, treating normal blood pressure increases a person's chance of cardiovascular death by 15%. However, the paper states "no conclusions can be made regarding people with type 1 diabetes or patients with diabetes and normal blood pressure levels".

 

[noblehead]

You were treated for normal blood pressure, not high blood pressure. From the study, treating normal blood pressure increases a person's chance of cardiovascular death by 15%. However, the paper states "no conclusions can be made regarding people with type 1 diabetes or patients with diabetes and normal blood pressure levels".

Yes I did see that bit.

 

[dbr10]

I'm glad I didn't fill my doctor's prescription for blood pressure pills. I had normal blood pressure, but it is apparently supposed to be standard practice to prescribe blood pressure lowering meds to all type 2 diabetics "to protect the kidneys". However, I think most doctors ignore this.

My BP came down on metformin and weight loss and was actually on the low side. Stopped taking the pills altogether.

 

[ann34+]

I find the whole issue confusing. In November last year a study in the Lancet -
The Lancet: Large meta-analysis finds lowering blood pressure below current targets benefits a wide range of patients -
seems to have found a bit differently. Also not sure how high blood pressure is defined? Are the figures given an average? My own blood pressure fluctuates a lot, some GPs talk about only chronic high blood pressure needing treatment, not ups and downs yet i have sometimes been told in clinic that even regular random high blood pressure, or 3-4 weeks of high pressure (eg. during and after a viral or other illness) shows treatment is needed long term, especially if there is a family history of stroke. My low dose ACE is useless for these high pressure periods.

 

[Totto]

My GP was about to prescribe ACE inhibitor for me at diagnosis but I stopped him doing this as my BP was 110/65 at the time.

 

[ann34+]

My GP was about to prescribe ACE inhibitor for me at diagnosis but I stopped him doing this as my BP was 110/65 at the time.

Amazed your doctor would think of ACE with that blood pressure. I went to that reading a couple of times on a low ACE medication some time ago and felt so faint i could hardly move.

 

[donnellysdogs]

Yep I was given ramipril years ago as a "you're diabetic" tablet. In A&E recently my readings were 100/50... So glad I didn't keep on the Ramipril all those years ago... I'd probably be one of the 15%!!! Even at the time I had low blood pressure not high....

 

[Totto]

Amazed your doctor would think of ACE with that blood pressure. I went to that reading a couple of times on a low ACE medication some time ago and felt so faint i could hardly move.

He just didn't think but was about to give me the starter packet of type 2 medications.
My BP is often 100/60 and below. You get used to it.

 

[doolallylady]

Probably a stupid question but what if you were being treated for High BP for a long time before being diagnosed? Does the diabetes make a difference?

 

[NoCrbs4Me]

Probably a stupid question but what if you were being treated for High BP for a long time before being diagnosed? Does the diabetes make a difference?

That should be fine, I would guess. The issue the study found a problem with was type 2s with normal blood pressure being prescribed blood pressure lowering meds.

 

[doolallylady]

Thank you for that, with so many things to think/worry about, another one really isn't needed.

 

[ann34+]

People with diabetes who have systolic blood pressure levels under 140 mm Hg and are treated with blood pressure-lowering drugs could have an increased risk of dying from cardiovascular causes, research suggests.

 

[ann34+]

Query re renin levels-
can't seem to post - continued from above - Any relationship with possibly more people with diabetes having certain renin levels?

Has anyone had their renin levels checked before treatment?
My renin levels have never been checked to my knowledge and i now have worse blood pressure levels than when i started - and cramps in legs and feet -cutting back now to see if improves, as problem started after a small increase.
Only just found this on the net, GP not aware meds can raise blood pressure in some people. Have i understood this research correctly?
Pressor Response to Initial Blood Pressure Monotherapy Is Associated With Cardiovascular Mortality
Commonly prescribed drugs used to lower blood pressure can actually have the opposite effect -- raising blood pressure in a statistically significant percentage of patients. A new study by researchers at Albert Einstein College of Medicine of Yeshiva University suggests that doctors could avoid this problem -- and select drugs most suitable for their patients -- by measuring blood levels of the enzyme renin through a blood test that is becoming more widely available.



http://ajh.oxfordjournals.org/content/28/2/232.abstract



Am J Hypertens (2015) 28 (2):232-238.

doi: 10.1093/ajh/hpu133

First published online: September 16, 2014[/QUOTE]