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Clinical Advisory:
Treating Hypertension in the Patient with Type 2 Diabetes
Statement by Claude Lenfant, M.D., Director National Heart, Lung, and Blood Institute

National Heart, Lung, and Blood Institute (NHLBI)
30 May 2000

A new clinical advisory issued by the National High Blood Pressure Education Program (NHBPEP) recommends that physicians pursue a more aggressive treatment approach to lower the blood pressure of patients who have both hypertension and diabetes.

The NHBPEP is coordinated by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. The "2000 Clinical Advisory Treatment of Hypertension and Diabetes," is published in the latest issue of The Journal of Clinical Hypertension.

Both diabetes and hypertension are independent risk factors for cardiovascular disease (CVD). The advisory indicates that the coexistence of these conditions in a patient imposes a need for a significantly lower goal blood pressure (135/80 mm Hg) than the goal blood pressure recommended for a patient with hypertension who does not have diabetes (140/90 mm Hg). Over 5 million Americans have type 2 diabetes and high blood pressure. Uncontrolled hypertension leads to stroke, heart failure, and kidney failure. It is clear that the combination of these two CVD risk factors has important public health implications.

This new report is part of a series of clinical advisories being issued by NHLBI to raise health professional and consumer awareness of the health dangers posed by high blood pressure. On May 4, 2000, NHLBI issued a clinical advisory to draw attention to the problem of high systolic blood pressure. Systolic blood pressure measures the force exerted by the blood as it flows through the arteries when the heart contracts. It is expressed as the top number of the blood pressure reading and now is recognized to be the most important indicator of heart disease risk in adults age 60 and older.

The authors of the new advisory note results from several studies showing that efforts to lower high blood pressure in patients with type 2 diabetes produce dramatic results. In one study, near optimal control of hypertension (144/82 mm Hg) led to 44 percent fewer diabetes-related strokes, 37 percent fewer cases of small blood vessel damage due to diabetes (particularly diabetic retinopathy), and 32 percent fewer diabetes-related deaths. Another study reported CVD deaths were reduced 76 percent in hypertensive patients who had type 2 diabetes and 13 percent in patients who had hypertension but no diabetes.

The clinical advisory is an update to the Sixth Report of the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC VI). JNC VI was produced in 1997 by the NHBPEP, a federation of 45 professional, voluntary, and official agencies.

To learn more about prevention and treatment of high blood pressure, visit NHLBI's new, interactive high blood pressure Web site for consumers and health professionals at //