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Aggressive Blood Pressure Control Reduces Cardiovascular Events in Diabetics with Peripheral Arterial Disease: Presented at AHA

By Jill Stein

CHICAGO, IL -- November 18, 2002 -- New data suggest that intensive reduction of blood pressure in diabetic patients with peripheral arterial disease is effective in preventing adverse cardiovascular events.

Based on these findings, researchers say that intensified efforts to treat hypertension aggressively is justified in patients with PAD.

Dr. Philip Mehler with the University of Colorado Health Sciences Center, in Denver, Colorado, United States, reported the data here November 17 at the American Heart Association 2002 Scientific Sessions.

Peripheral arterial disease is associated with a six- fold increase in cardiovascular mortality and a 30 to 50 percent increase in morbidity, he explained..

His group conducted an interventional study of a normotensive and hypertensive cohort, to evaluate the effects of intensive versus moderate diastolic blood pressure control on diabetic microvascular and macrovascular complications.

The 220 subjects in the normotensive cohort, received intensive treatment arm with the goal of decreasing diastolic blood pressure by 10 mm Hg, with further random assignment to receive either nisoldipine or enalapril. The 227 patients randomised to the moderate treatment group had no intended change in diastolic blood pressure. Results showed that intensive treatment of diastolic blood pressure was associated with three cardiovascular events in 22 patients (13.6 percent) versus 12 cardiovascular events in 31 patients (38.7 percent) in the moderate diastolic blood pressure treatment arm (p=0.046).

At an ankle brachial index (ABI) of 0.50, the adjusted odds ratio of a cardiovascular event in the intensively treated group was 0.108 compared with the moderate group. In the PAD patients treated moderately there was an inverse relationship between ABI and risk of cardiovascular events (p=0.009). This relationship was abolished in the intensive treatment arm such that even at the lowest ABI, intensively-treated subjects had no relevant increased risk of events (p=0.91).

The protective effect of intensive diastolic blood pressure control was independent of antihypertensive drug class, Dr. Mehler said.

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