Got Type Two? Hypertension Drugs Can Wait

Type 2 diabetes patients with hypertension do not need to rush to drug treatment

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) People with type 2 diabetes have to keep a close eye on their blood pressure. But that does not mean they have to start taking blood pressure drugs the minute they are diagnosed.

Middle-aged diabetes patients with high blood pressure have time to learn how to manage their blood pressure without the use of medications.

Waiting up to a year before starting drug treatment for high blood pressure leads to only a small reduction in life expectancy.

"Learn to control your blood pressure without drugs."

High blood pressure - or hypertension - is harmful for anyone with or without diabetes. Having said that, diabetes patients with high blood pressure have an especially high risk for stroke, heart disease, kidney failure, loss of vision, and amputations.

Even though controlling high blood pressure can prevent these health problems, doctors and patients alike often fail to take the steps needed to lower blood pressure.

Many patients do not make the proper lifestyle changes, while their doctors can be hesitant to put them on additional drugs.

Until recently, the consequences of these treatment delays had not been measured. Neda Laiteerapong, M.D., of the University of Chicago, and colleagues used computer software to find out how much harm is caused by different delays in managing blood pressure in recently diagnosed diabetes patients.

The researchers found that a one-year delay causes only small damage. However, waiting 10 years or more can cause as much damage as smoking does in patients with heart disease.

According to both the American Diabetes Association and the National Institutes of Health, diabetes patients should aim for a blood pressure below 130/80 mmHg, a target that is lower than that recommended for the general public.

Yet, about two-thirds of adults with diabetes do not reach that goal, either because they lack access to proper health care or due to what can be called "clinical inertia" - when patients do not make lifestyle changes or when doctors are hesitant to push additional medications.

Most experts recommend that diabetes patients with moderately high blood pressure starting taking blood pressure medications within three months. For those with dangerously high blood pressure, they recommend starting drug treatment immediately.

The problem with beginning drug treatment so early is that patients do not have enough time to learn good habits and make the necessary lifestyle changes. Starting drug treatment early also means that patients have to start paying for those drugs sooner.

"We ask patients with diabetes to do a billion things," says Dr. Laiteerapong. Patients have to juggle a variety of tasks, including testing their blood sugar, counting carbohydrates, and exercising for half an hour each day.

"Most, if not all, of this is new to them," Dr. Laiteerapong explains. "They need time to adapt. It's important to do this right, but our results say it's not that important to do it so fast."

The study's findings suggest that doctors should work with patients to help them learn the necessary skills instead of racing into drug treatment.

According to the authors, diabetes patients with high blood pressure have "at least up to one year to focus on diabetes self-management and lifestyle modification." That is, they have more time.

For their study, Dr. Laiteerapong and colleagues ran published data through computer software to determine the extent to which delaying hypertension treatment caused harm to recently diagnosed type 2 diabetes patients between 50 and 59 years of age.

"Among middle-aged adults with diabetes, the harms of a one-year delay in managing blood pressure may be small," the researchers conclude.

"Health care providers may wish to focus on diabetes management alone in the first year after diagnosis to help patients establish effective self-management and lifestyle modification.

However, after the first year, it is clear that achieving and maintaining tight blood pressure control among US middle-aged adults with diabetes has the potential to generate substantial population-level health benefits."

In other words, blood pressure drugs can wait. But after one year, it is clear that drug treatment is extremely valuable to the health of patients.

The study - which received financial support from the National Institutes of Health - is published in the Journal of General Internal Medicine

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Review Date: 
January 13, 2012
Last Updated:
January 16, 2012