Type 2 diabetes and high blood pressure How explosive is the cocktail?

Type 2 diabetes and high blood pressureHow explosive is the cocktail?

Type 2 diabetes and high blood pressure- How explosive is the cocktail? -

I Epidemiology of type 2 diabetes and hypertension

II Risks for hypertensive patients with diabetes

III Guidelines position

Two diabetic patients out of three also suffer from hypertension

Worldwide epidemiology

1 billion hypertensive patients

387 million patients with type 2 diabetes

258 million hypertensive patients with type 2

diabetes

WHO 2013. IDF 2015. Ferrannini E, Cushman WC. Lancet. 2012;380(9841):601-610.

Excess cardiovascular risk in diabetic patients is attributable to coexistent hypertension

Ferrannini E, Cushman WC. Lancet. 2012;380(9841):601-610.

All-cause mortality

“Participants with hypertension at the time of diabetes diagnosis had higher rates of all-cause mortality and cardiovascular

disease than did people with diabetes without hypertension”

+72%Cardiovascul

ar disease event

+57%

Reduce mortality rate in patients with diabetes remains an important challenge

Type 2 diabetes increases mortality risk by two-fold, macrovascular disease is

the predominant cause of death

Nwaneri C et al. Br J Diabetes Vasc Dis. 2013;13:192-207.Gregg EW et al. N Engl J Med. 2014;370(16):1514-1523.

Type 2 diabetes is associated with twice higher risk of MI and 1.5 higher risk of

stroke

Early control of blood pressure in hypertensive diabetic patients is essential to avoid early risk

CV = Cardiovascular, MI = myocardial infarctionRetrospective cohort. n=15 665 hypertensive diabetic patients without coronary disease and without a history of stroke.Adjusted incidence RRs for stroke, myocardial infarction, and other major cardiovascular events were estimated based on the mean level of BP control in the year after onset of hypertension. O’Connor PJ et al. Diabetes Care. 2013;36(2):322-327.

A diabetic patient whose blood pressure is not controlled within a year after hypertension onset has a 30% increased risk of CV events at 3 years

The 2013 ESH/ESC guidelines recommend a target BP of 140/85 mm Hg

The early initiation of a antihypertensive treatment and the use of multiple therapy at high doses are favored by the ADA guidelines