Blood Pressure Before Blood Sugar

Diabetes patients avoid heart disease hospitalization through focus on blood pressure and cholesterol control

(RxWiki News) Heart disease is one of the most common complications of diabetes. As such, diabetes patients must keep a close eye on measures of heart health, including blood pressure and cholesterol levels.

One of the main goals of diabetes treatment is to control blood sugar levels. However, findings from a recent study suggested that meeting the recommended targets for blood pressure and cholesterol may be even more important than blood sugar control when it comes to preventing heart disease in patients with type 2 diabetes.

Results showed that rates of hospitalization for heart disease were lowest among diabetes patients who met targets for all three risk factors (blood sugar, blood pressure and cholesterol) or targets for just blood pressure and cholesterol. In contrast, heart disease hospitalization rates were highest among those with no controlled risk factors or only blood sugar control.

"Watch your blood pressure and cholesterol if you have diabetes."

Gregory A. Nichols, PhD, of Kaiser Permanente Center for Health Research, led the investigation that looked into the relationship between control of blood sugar, blood pressure and cholesterol and the risk of hospitalization for heart disease.

The study included 26,636 patients with type 2 diabetes. Participants' blood sugar was determined using HbA1c - a measure of blood sugar over the past three months. Blood pressure was measured as systolic pressure, or the amount of pressure blood puts on the arteries when the heart beats. Researchers also measured levels of LDL cholesterol, also known as the "bad" cholesterol.

A normal HbA1c reading is generally under 5.7 percent. According to the American Diabetes Association, adults with diabetes should aim for an HbA1c blood sugar level of less than 7 percent. The American Diabetes Association also recommends that diabetes patients should try to maintain a systolic blood pressure of less than 130 mmHg and an LDL cholesterol level of less than 100 mg/dl. Normal systolic pressure is usually around 120 mmHg and most people are told to bring LDL cholesterol levels below 100 mg/dl.

For their study, Dr. Nichols and colleagues followed participants from 2002 through 2010, or until they died, left the study or were hospitalized for a heart problem such as heart attack or stroke.

About 13 percent of participants achieved the recommended goals for all three risk factors. Hospitalization rates for heart disease among these patients were about two and a half times lower than patients who did not achieve any of the targets.

Specifically, rates of hospitalization for heart disease were:

  • 18.2 per 1,000 person-years among patients with no controlled risk factors
  • 16.9 per 1,000 person-years among patients with only HbA1c in control
  • 7.2 per 1,000 person-years among patients with all three risk factors controlled
  • 6.1 per 1,000 person-years among patients with systolic blood pressure and LDL cholesterol in control.

Rates of hospitalization for heart disease were similar among patients with only systolic pressure or LDL cholesterol in control, only HbA1c and systolic pressure controlled or only HbA1c and LDL cholesterol controlled.

"People with diabetes are often focused on controlling their blood sugar, but our study found that controlling blood pressure and cholesterol is even more important in preventing heart disease," said Dr. Nichols in a press release. "This doesn’t mean that people with diabetes should ignore their blood sugar levels. They should still get regular HbA1c tests to measure and control their blood [sugar], but it’s also important to pay attention to other factors that increase the risk for cardiovascular disease."

Paul A. Tucker II, MD, Chief of Cardiology at St. David’s South Austin Medical Center and dailyRx Contributing Expert agreed "This study reemphasizes the importance of good blood pressure and cholesterol control in diabetic patients. Taking an ace-inhibitor and a statin, if tolerated, is the ideal therapy for patients with diabetes, hypertension and high cholesterol."

The study was published in January in the Journal of General Internal Medicine. The research was funded by AstraZeneca LP and Bristol Myers-Squibb, two companies that manufacture diabetes medications. Two of the study's authors reported ties to AstraZeneca.

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Review Date: 
January 30, 2013