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(Hypertension. 2001;38:e11.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Diabetes, Hypertension, and Cardiovascular Disease: An Update

Franz H. Messerli; Ehud Grossman

Ochsner Clinic and, Alton Ochsner Medical Foundation, New Orleans, Louisiana
Internal Medicine D, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Hashomer, Israel

To the Editor:

Sowers et al are to be commended for writing a thorough review on the diabetic hypertensive patient.¹ In doing so, they came to the conclusion that, "Results of the SHEP) [2] and the UKPDS) [3] trials suggest that diuretics and ß-blockers as well as ACE inhibitors are also useful therapeutic agents in diabetic hypertensive patients who often require 2 drugs to control blood pressure adequately. [4]") Although we agree with this statement, it should be pointed out that ß-blockers seem to be far less efficacious than the other drug classes in this subpopulation. The UKPDS (UK Prospective Diabetes Study) has demonstrated that coronary heart disease is much more prevalent than cerebrovascular disease in the diabetic hypertensive patient. In fact, in the UKPDS, morbidity and mortality events from coronary heart disease were between 4 to 6 times more common than events from cerebrovascular disease. Thus, any drug class used to treat the hypertensive diabetic population should exert some primary cardioprotective efficacy, ie, lower the risk of coronary heart disease. Unfortunately, antihypertensive therapy in the UKPDS had no effect on coronary artery disease (Figure). As Sowers et al pointed out, half of these patients were treated with an ACE inhibitor (captopril) and half with a ß-blocker (atenolol), but there was no significant difference between the 2 treatment strategies. Similar to our previous findings in hypertension in the elderly,⁵ ß-blockers failed to exert a primary cardioprotective effect in the diabetic patient in the UKPDS. Further, ß-blockers have well-documented detrimental effects on . . . [Full Text of this Article]

James R. Sowers

Endocrinology, Diabetes, and Hypertension, SUNY Health Science Center at Brooklyn, New York