Controlling blood pressure could save lives of diabetics

People with diabetes have to watch not only their blood sugar level but their blood pressure as well.

A number of large-scale studies have shown that having a blood pressure less than 130/80 mm Hg (millimeter of mercury) greatly reduces the risk of diabetes-related complications such as heart attack and stroke.

The Hypertension Optimal Treatment (HOT) trial published in the Lancet demonstrated that tight blood pressure control using a combination of antihypertension drugs felodipine and ramipril resulted in a fewer incidence of stroke and heart attack.

In the HOT trial, the risk of diabetics dying from cardiovascular diseases in the next four years was reduced by 50 percent when their blood pressure was kept within target levels.

Another study, the United Kingdom Prospective Diabetes Study (UKPDS), underscored the fact that good blood pressure control is as important as maintaining the target blood sugar levels.

The study reported that stricter control of blood pressure reduces the risk of diabetes complications by 24 percent and stroke by 44 percent.

It is estimated that as much as one-third of diabetics have hypertension. "Tight control of blood pressure, side by side with glycemic (blood sugar) control, is very important in the diabetic patient," said Dr. Joselynna Quimpo, a diabetes specialist and fellow of the Philippine Society of Endocrinology and Metabolism.

Diabetics who have a systolic blood pressure between 130 and 139 mm Hg and a diastolic blood pressure between 80 and 89 mm Hg are advised to modify their lifestyle by quitting smoking, eating a healthy diet and exercising regularly.

If the blood pressure has not reached target levels after three months, antihypertensive medicines will be prescribed to go along with lifestyle changes.

Unlike people with mild hypertension, most diabetics need more than one type of antihypertensive drug to decrease blood pressure. Latest guidelines in treating hypertension recommend using combination drugs to achieve blood pressure level targets.

One of the drugs now available in the Philippines is a combination of two types of antihypertensive agents, the ACE inhibitor ramipril and calcium channel blocker felodipine.

The ramipril and felopidine come in a fixed dose combination which makes it more convenient to patients and thus increasing patient compliance.

The fixed dose is less costly than each of the medicines bought separately. An affordable combination antihypertensive medicine increases the chances of patients complying with long-term treatment of the condition.

The combination of ramipril and felodipine in one pill has shown a better response in lowering blood pressure than each of the medicine taken separately, according to Quimpo.

"Over the years, ACE inhibitors such as ramipril have been used for hypertension and other heart problems. For 2005, what is offered to us is a combination of ramipril and felodipine to treat our hypertensive diabetic patients," she said.

Felodipine is ideal for diabetics with hypertension because it does not increase cholesterol levels and also has the ability to protect the kidney just like ramipril.

The fixed dose combination of ramipril and felodipine is a prescription medicine launched recently by Sanofi-Aventis.