In the News

Lower blood pressure decreases heart attack risk in diabetics with clogged leg arteries
According to a study reported in the February 3, 2003 issue of Circulation: Journal of the American Heart Association, lowering blood pressure can reduce heart attacks and other cardiovascular events in people with diabetes who also have clogged leg arteries, known as peripheral arterial disease or PAD. In PAD, fatty deposits build up along artery walls and reduce blood circulation, mainly in arteries leading to the legs and feet and can lead to cardiovascular events such as heart attack or stroke. Key risk factors for PAD include diabetes and high blood pressure. PAD affects 8 to 12 million Americans. About 50 million Americans have high blood pressure.

According to the publication in the journal Circulation, researchers for the Appropriate Blood Pressure Control in Diabetes (ABCD) study followed 950 people with type 2 diabetes (also called adult-onset diabetes) for five years. At the beginning of the study, 480 had normal blood pressure, and 53 had PAD. Participants were split into two groups.

Patients in the moderate treatment group took a placebo and had average blood pressure of 137/81 mm Hg (millimeters of mercury) during the last four years of the study. Those assigned to the intensive treatment group took the blood pressure-lowering medicines enalapril (an ACE inhibitor) or nisoldipine (a calcium-channel blocker) and had an average blood pressure of 128/75 mm Hg. Researchers also measured patients' ankle brachial index (ABI), which is an indication of blocked arteries in the leg.

There were 22 PAD patients in the intensive treatment group and 31 in the moderate treatment group. In patients with PAD, 12 cardiovascular events (38.7 percent) occurred among those on moderate treatment compared with three events (13.6 percent) on intensive treatment.

The ABCD study showed that intensive blood pressure lowering was effective in reducing the risk of cardiovascular events in PAD patients. Additional studies will need to be performed to determine whether intensive blood pressure control improves cardiovascular outcomes in patients with PAD. The study confirmed that blood pressure control is especially advantageous in the diabetic population.

Study Suggests Diuretics For Treating High Blood Pressure
The results from the largest antihypertensive trial and the second largest lipid-lowering trial were reported in December. The trial, called ALLHAT, compared the drugs for use in beginning initial treatment for high blood pressure. It was conducted over eight years in 623 sites throughout the U.S, Puerto Rico, the Virgin Islands, and Canada and enrolled 42,418 participants and was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

Results showed that less costly, traditional diuretics (sometimes called water pills) work better than newer medicines to treat high blood pressure and prevent some forms of heart disease. The newly reported findings showed a slightly greater percentage of patients got their blood pressure below 140/90 when they used the diuretic compared with the ACE inhibitor or calcium channel blocker. Researchers also found the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and chest pains. Not all patients can take diuretics, so it is essential to talk with oneีs physician before stopping or changing any medication.