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(Hypertension. 2007;49:13.)
© 2007 American Heart Association, Inc.

Editorial Commentaries

How Do You Define "Hypertension" in a Patient With Type 1 Diabetes?

Matthew R. Weir

From the University of Maryland School of Medicine, Baltimore.

Correspondence to Matthew R. Weir, Division of Nephrology, University of Maryland School of Medicine, 22 S Greene St, Room N3W143, Baltimore, MD 21201. E-mail mweir@medicine.umaryland.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The definition of "hypertension" is an arbitrary term, which refers to a level of blood pressure that carries increased risk for cardiovascular morbidity and mortality. Given that patients with type 1 diabetes have more baseline risk for vascular disease than the general population, many consensus guidelines committees have recommended lower blood pressure goals, preferably <130/80 mm Hg.^1,2 These recommendations are, in large part, based on observational and interventional studies in people with type 2 diabetes. Moreover, as one evaluates both observational and interventional clinical trial data, it is quite clear that there is a continuous relationship between blood pressure and cardiovascular events.^3,4 Thus, although guidelines recommend lower target blood pressures, what is the correct number in a type 1 diabetic? In addition, does this depend on the presence or absence of microalbuminuria or other subclinical measures of cardiovascular disease?

Older clinical trial data in patients with type 1 diabetes provided the suggestion that lower blood pressure goals might provide clinical benefit. Viberti et al⁵ reported that type 1 and type 2 diabetics with a mean blood pressure of 127/78 mm Hg derived advantage from captopril therapy (associated with a blood pressure reduction of 4/2 mm Hg) compared with placebo in reducing the likelihood of progression from microalbuminuria to macroalbuminuria (Figure). Ravid et al⁶ demonstrated similar benefits with enalapril in type 2 diabetics. The MICRO-Heart Outcomes Prevention Evaluation data also indicated that lower blood pressure (3/2 mm Hg) with ramipril therapy also reduced the risk of progression from microalbuminuria . . . [Full Text of this Article]

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Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes

Anoop Shankar, Ronald Klein, Barbara E.K. Klein, F. Javier Nieto, and Scot E. Moss
Hypertension 2007 49: 48-54. [Abstract] [Full Text] [PDF]