Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension
Jaakko Tuomilehto, M.D., Daiva Rastenyte, M.D., Willem H. Birkenhäger, M.D., Lutgarde Thijs, B.Sc., Riitta Antikainen, M.D., Christopher J. Bulpitt, M.D., Astrid E. Fletcher, Ph.D., Françoise Forette, M.D., Adiv Goldhaber, M.D., Paolo Palatini, M.D., Cinzia Sarti, M.D., Robert Fagard, M.D., Jan A. Staessen, M.D., Ph.D., for The Systolic Hypertension in Europe Trial Investigators
Background Recent reports suggest that calcium-channel blockersmay be harmful in patients with diabetes and hypertension. Wepreviously reported that antihypertensive treatment with thecalcium-channel blocker nitrendipine reduced the risk of cardiovascularevents. In this post hoc analysis, we compared the outcome oftreatment with nitrendipine in diabetic and nondiabetic patients.
Methods After stratification according to center, sex, and presenceor absence of previous cardiovascular complications, 4695 patients(age, 60 years) with systolic blood pressure of 160 to 219 mmHg and diastolic pressure below 95 mm Hg were randomly assignedto receive active treatment or placebo. Active treatment consistedof nitrendipine (10 to 40 mg per day) with the possible additionor substitution of enalapril (5 to 20 mg per day) or hydrochlorothiazide(12.5 to 25 mg per day) or both, titrated to reduce the systolicblood pressure by at least 20 mm Hg and to less than 150 mmHg. In the control group, matching placebo tablets were administeredsimilarly.
Results At randomization, 492 patients (10.5 percent) had diabetes.After a median follow-up of two years, the systolic and diastolicblood pressures in the placebo and active-treatment groups differedby 8.6 and 3.9 mm Hg, respectively, among the diabetic patients.Among the 4203 patients without diabetes, systolic and diastolicpressures differed by 10.3 and 4.5 mm Hg, respectively, in thetwo groups. After adjustment for possible confounders, activetreatment was found to have reduced overall mortality by 55percent (from 45.1 deaths per 1000 patients to 26.4 deaths per1000 patients), mortality from cardiovascular disease by 76percent, all cardiovascular events combined by 69 percent, fataland nonfatal strokes by 73 percent, and all cardiac events combinedby 63 percent in the group of patients with diabetes. Amongthe nondiabetic patients, active treatment decreased all cardiovascularevents combined by 26 percent and fatal and nonfatal strokesby 38 percent. In the group of patients receiving active treatment,reductions in overall mortality, mortality from cardiovasculardisease, and all cardiovascular events were significantly largeramong the diabetic patients than among the nondiabetic patients(P=0.04, P=0.02, and P=0.01, respectively).
Conclusions Nitrendipine-based antihypertensive therapy is particularlybeneficial in older patients with diabetes and isolated systolichypertension. Thus, our findings do not support the hypothesisthat the use of long-acting calcium-channel blockers may beharmful in diabetic patients.
Source Information
From the National Public Health Institute, Helsinki, Finland (J.T., C.S.); the Institute of Cardiology, Kaunas, Lithuania (D.R.); Erasmus University, Rotterdam, the Netherlands (W.H.B.); the Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, Leuven, Belgium (L.T., R.F.); the Health Center Hospital of Oulu and the Department of Internal Medicine, Oulu University Hospital, Oulu, Finland (R.A.); Hammersmith Hospital, Imperial College, London (C.J.B.); the London School of Hygiene and Tropical Medicine, London (A.E.F.), Hôpital Broca, Paris (F.F.); Ranana, Israel (A.G.); and the Institute of Clinical Medicine, Padua, Italy (P.P.). Jan A. Staessen, M.D., Ph.D., Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Leuven, Belgium, was also an author.
Address reprint requests to Dr. Jan A. Staessen at the Coordinating Office of the Syst-Eur Trial, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Campus Gasthuisberg, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium, or at jan.staessen{at}med.kuleuven.ac.be.
On behalf of the Canadian Hypertension Education P,
(2009). 2009 Canadian Hypertension Education Program recommendations: An annual update. cfp
55: 697-700
[Full Text]
Elijovich, F., Laffer, C.
(2009). A role for single-pill triple therapy in hypertension. Ther Adv Cardiovasc Dis
3: 231-240
[Abstract]
McGill, J. B.
(2009). Reexamining Misconceptions About {beta}-Blockers in Patients With Diabetes. Clin. Diabetes
27: 36-46
[Abstract][Full Text]
Kloner, R. A, Neutel, J., Roth, E. M, Weiss, R., Weinberger, M. H, Thakker, K. M, Schwartz, B., Shi, H., Gregg, A.-M., the ADHT Investigators,
(2008). Blood Pressure Control with Amlodipine Add-on Therapy in Patients with Hypertension and Diabetes: Results of the Amlodipine Diabetic Hypertension Efficacy Response Evaluation Trial. The Annals of Pharmacotherapy
42: 1552-1562
[Abstract][Full Text]
Zhang, Y., Galloway, J. M., Welty, T. K., Wiebers, D. O., Whisnant, J. P., Devereux, R. B., Kizer, J. R., Howard, B. V., Cowan, L. D., Yeh, J., Howard, W. J., Wang, W., Best, L., Lee, E. T.
(2008). Incidence and Risk Factors for Stroke in American Indians: The Strong Heart Study. Circulation
118: 1577-1584
[Abstract][Full Text]
U.S. Preventive Services Task Force,
(2008). Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement. ANN INTERN MED
148: 846-854
[Abstract][Full Text]
Bloomgarden, Z. T.
(2008). Cardiovascular Disease in Diabetes. Diabetes Care
31: 1260-1266
[Full Text]
Marwick, T H
(2008). Diabetic heart disease. Postgrad. Med. J.
84: 188-192
[Abstract][Full Text]
Osher, E., Stern, N.
(2008). Diastolic Pressure in Type 2 Diabetes: Can target systolic pressure be reached without "diastolic hypotension"?. Diabetes Care
31: S249-S254
[Abstract][Full Text]
Hu, G., Jousilahti, P., Tuomilehto, J.
(2007). Joint effects of history of hypertension at baseline and type 2 diabetes at baseline and during follow-up on the risk of coronary heart disease. Eur Heart J
28: 3059-3066
[Abstract][Full Text]
Air, E. L., Kissela, B. M.
(2007). Diabetes, the Metabolic Syndrome, and Ischemic Stroke: Epidemiology and possible mechanisms. Diabetes Care
30: 3131-3140
[Full Text]
Naik, A. D., Issac, T. T., Street, R. L. Jr, Kunik, M. E.
(2007). Understanding the Quality Chasm for Hypertension Control in Diabetes: A Structured Review of "Co-maneuvers" Used in Clinical Trials. J Am Board Fam Med
20: 469-478
[Abstract][Full Text]
Tentori, F., Hunt, W. C., Rohrscheib, M., Zhu, M., Stidley, C. A., Servilla, K., Miskulin, D., Meyer, K. B., Bedrick, E. J., Johnson, H. K., Zager, P. G.
(2007). Which Targets in Clinical Practice Guidelines Are Associated with Improved Survival in a Large Dialysis Organization?. J. Am. Soc. Nephrol.
18: 2377-2384
[Abstract][Full Text]
Umpierrez, G. E., Cantey, P., Smiley, D., Palacio, A., Temponi, D., Luster, K., Chapman, A.
(2007). Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension. Diabetes Care
30: 1699-1703
[Abstract][Full Text]
Rosenthal, T., Rosenmann, E., Tomassoni, D., Amenta, F.
(2007). Effect of Lercanidipine on Kidney Microanatomy in Cohen-Rosenthal Diabetic Hypertensive Rats. J CARDIOVASC PHARMACOL THER
12: 145-152
[Abstract]
Authors/Task Force Members, , Ryden, L., Standl, E., Bartnik, M., Berghe, G. V. d., Betteridge, J., de Boer, M.-J., Cosentino, F., Jonsson, B., Laakso, M., Malmberg, K., Priori, S., Ostergren, J., Tuomilehto, J., Thrainsdottir, I., Other Contributors, , Vanhorebeek, I., Stramba-Badiale, M., Lindgren, P., Qiao, Q., ESC Committee for Practice Guidelines (CPG), , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, J., Dean, V., Deckers, J., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J., Zamorano, J. L., Document Reviewers, , Deckers, J. W., Bertrand, M., Charbonnel, B., Erdmann, E., Ferrannini, E., Flyvbjerg, A., Gohlke, H., Juanatey, J. R. G., Graham, I., Monteiro, P. F., Parhofer, K., Pyorala, K., Raz, I., Schernthaner, G., Volpe, M., Wood, D.
(2007). Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J Suppl
9: C3-C74
[Full Text]
Authors/Task Force Members, , Ryden, L., Standl, E., Bartnik, M., Van den Berghe, G., Betteridge, J., de Boer, M.-J., Cosentino, F., Jonsson, B., Laakso, M., Malmberg, K., Priori, S., Ostergren, J., Tuomilehto, J., Thrainsdottir, I., Other Contributors, , Vanhorebeek, I., Stramba-Badiale, M., Lindgren, P., Qiao, Q., ESC Committee for Practice Guidelines (CPG), , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, J., Dean, V., Deckers, J., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J., Zamorano, J. L., Document Reviewers, , Deckers, J. W., Bertrand, M., Charbonnel, B., Erdmann, E., Ferrannini, E., Flyvbjerg, A., Gohlke, H., Juanatey, J. R. G., Graham, I., Monteiro, P. F., Parhofer, K., Pyorala, K., Raz, I., Schernthaner, G., Volpe, M., Wood, D.
(2007). Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J
28: 88-136
[Full Text]
Dzau, V. J., Antman, E. M., Black, H. R., Hayes, D. L., Manson, J. E., Plutzky, J., Popma, J. J., Stevenson, W.
(2006). The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes: Part I: Pathophysiology and Clinical Trial Evidence (Risk Factors Through Stable Coronary Artery Disease). Circulation
114: 2850-2870
[Full Text]
Vermeer, S. E., Sandee, W., Algra, A., Koudstaal, P. J., Kappelle, L. J., Dippel, D. W.J., on behalf of the Dutch TIA Trial Study Group,
(2006). Impaired Glucose Tolerance Increases Stroke Risk in Nondiabetic Patients With Transient Ischemic Attack or Minor Ischemic Stroke. Stroke
37: 1413-1417
[Abstract][Full Text]
Matz, K., Keresztes, K., Tatschl, C., Nowotny, M., Dachenhausen, A., Brainin, M., Tuomilehto, J.
(2006). Disorders of Glucose Metabolism in Acute Stroke Patients: An underrecognized problem. Diabetes Care
29: 792-797
[Abstract][Full Text]
Sacco, R. L., Adams, R., Albers, G., Alberts, M. J., Benavente, O., Furie, K., Goldstein, L. B., Gorelick, P., Halperin, J., Harbaugh, R., Johnston, S. C., Katzan, I., Kelly-Hayes, M., Kenton, E. J., Marks, M., Schwamm, L. H., Tomsick, T.
(2006). Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.. Circulation
113: e409-e449
[Abstract][Full Text]
Marwick, T H
(2006). Diabetic heart disease. Heart
92: 296-300
[Abstract][Full Text]
Sacco, R. L., Adams, R., Albers, G., Alberts, M. J., Benavente, O., Furie, K., Goldstein, L. B., Gorelick, P., Halperin, J., Harbaugh, R., Johnston, S. C., Katzan, I., Kelly-Hayes, M., Kenton, E. J., Marks, M., Schwamm, L. H., Tomsick, T.
(2006). Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.. Stroke
37: 577-617
[Abstract][Full Text]
Stults, B., Jones, R. E.
(2006). Management of Hypertension in Diabetes. Diabetes Spectr.
19: 25-31
[Abstract][Full Text]
Berl, T., Henrich, W.
(2006). Kidney-Heart Interactions: Epidemiology, Pathogenesis, and Treatment. CJASN
1: 8-18
[Full Text]
Prepared by: British Cardiac Society, British Hype,
(2005). JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart
91: v1-v52
[Full Text]
Hu, G., Sarti, C., Jousilahti, P., Peltonen, M., Qiao, Q., Antikainen, R., Tuomilehto, J.
(2005). The Impact of History of Hypertension and Type 2 Diabetes at Baseline on the Incidence of Stroke and Stroke Mortality. Stroke
36: 2538-2543
[Abstract][Full Text]
Strippoli, G. F.M., Craig, M., Schena, F. P., Craig, J. C.
(2005). Antihypertensive Agents for Primary Prevention of Diabetic Nephropathy. J. Am. Soc. Nephrol.
16: 3081-3091
[Abstract][Full Text]
Meneilly, G. S.
(2005). Diabetes Is Common in Elderly Persons. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
60: 1145-1146
[Full Text]
Verdecchia, P., Reboldi, G., Angeli, F., Gattobigio, R., Bentivoglio, M., Thijs, L., Staessen, J. A., Porcellati, C.
(2005). Angiotensin-Converting Enzyme Inhibitors and Calcium Channel Blockers for Coronary Heart Disease and Stroke Prevention. Hypertension
46: 386-392
[Abstract][Full Text]
Berl, T., Hunsicker, L. G., Lewis, J. B., Pfeffer, M. A., Porush, J. G., Rouleau, J.-L., Drury, P. L., Esmatjes, E., Hricik, D., Pohl, M., Raz, I., Vanhille, P., Wiegmann, T. B., Wolfe, B. M., Locatelli, F., Goldhaber, S. Z., Lewis, E. J., for the Collaborative Study Group,
(2005). Impact of Achieved Blood Pressure on Cardiovascular Outcomes in the Irbesartan Diabetic Nephropathy Trial. J. Am. Soc. Nephrol.
16: 2170-2179
[Abstract][Full Text]
Whelton, P. K., Barzilay, J., Cushman, W. C., Davis, B. R., IIamathi, E., Kostis, J. B., Leenen, F. H. H., Louis, G. T., Margolis, K. L., Mathis, D. E., Moloo, J., Nwachuku, C., Panebianco, D., Parish, D. C., Pressel, S., Simmons, D. L., Thadani, U., for the ALLHAT Collaborative Research Group,
(2005). Clinical Outcomes in Antihypertensive Treatment of Type 2 Diabetes, Impaired Fasting Glucose Concentration, and Normoglycemia: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med
165: 1401-1409
[Abstract][Full Text]
Tuomilehto, J., Lindstrom, J., Qiao, Q.
(2005). Strategies for the prevention of type 2 diabetes and cardiovascular disease. Eur Heart J Suppl
7: D18-D22
[Full Text]
Hu, G., Jousilahti, P., Qiao, Q., Peltonen, M., Katoh, S., Tuomilehto, J.
(2005). The Gender-Specific Impact of Diabetes and Myocardial Infarction at Baseline and During Follow-Up on Mortality From All Causes and Coronary Heart Disease. J Am Coll Cardiol
45: 1413-1418
[Abstract][Full Text]
Ravera, M., Ratto, E., Vettoretti, S., Parodi, D., Deferrari, G.
(2005). Prevention and Treatment of Diabetic Nephropathy: The Program for Irbesartan Mortality and Morbidity Evaluation. J. Am. Soc. Nephrol.
16: S48-S52
[Abstract][Full Text]
Sowers, J. R., White, W. B., Pitt, B., Whelton, A., Simon, L. S., Winer, N., Kivitz, A., van Ingen, H., Brabant, T., Fort, J. G., for the Celecoxib Rofecoxib Efficacy and Safety in,
(2005). The Effects of Cyclooxygenase-2 Inhibitors and Nonsteroidal Anti-inflammatory Therapy on 24-Hour Blood Pressure in Patients With Hypertension, Osteoarthritis, and Type 2 Diabetes Mellitus. Arch Intern Med
165: 161-168
[Abstract][Full Text]
Baskar, V., Kamalakannan, D., Holland, M.R., Singh, B.M.
(2004). Hypertension in diabetes: is there a place for age-adjusted centile cut-offs in those aged <50 years?. QJM
97: 747-753
[Abstract][Full Text]
Sowers, J. R.
(2004). Treatment of Hypertension in Patients With Diabetes. Arch Intern Med
164: 1850-1857
[Abstract][Full Text]
Lim, H. S., MacFadyen, R. J., Lip, G. Y. H.
(2004). Diabetes Mellitus, the Renin-Angiotensin-Aldosterone System, and the Heart. Arch Intern Med
164: 1737-1748
[Abstract][Full Text]
Ronnback, M., Fagerudd, J., Forsblom, C., Pettersson-Fernholm, K., Reunanen, A., Groop, P.-H., on behalf of the Finnish Diabetic Nephropathy Stu,
(2004). Altered Age-Related Blood Pressure Pattern in Type 1 Diabetes. Circulation
110: 1076-1082
[Abstract][Full Text]
Benjamin, E. M.
(2004). Case Study: Treating Hypertension in Patients With Diabetes. Clin. Diabetes
22: 137-138
[Full Text]
Charbonnel, B., Dormandy, J., Erdmann, E., Massi-Benedetti, M., Skene, A.
(2004). The Prospective Pioglitazone Clinical Trial in Macrovascular Events (PROactive): Can pioglitazone reduce cardiovascular events in diabetes? Study design and baseline characteristics of 5,238 patients. Diabetes Care
27: 1647-1653
[Abstract][Full Text]
Trenkwalder, P.
(2004). Antihypertensive treatment with calcium channel blockers: pharmacological pornography or useful intervention?. Nephrol Dial Transplant
19: 17-20
[Full Text]
Deferrari, G., Ravera, M., Berruti, V., Leoncini, G., Deferrari, L.
(2004). Optimizing Therapy in the Diabetic Patient with Renal Disease: Antihypertensive Treatment. J. Am. Soc. Nephrol.
15: S6-11
[Abstract][Full Text]
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L. Jr, Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T. Jr, Roccella, E. J., the National High Blood Pressure Education Program,
(2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension
42: 1206-1252
[Abstract][Full Text]
Hurst, R. T., Lee, R. W.
(2003). Increased Incidence of Coronary Atherosclerosis in Type 2 Diabetes Mellitus: Mechanisms and Management. ANN INTERN MED
139: 824-834
[Abstract][Full Text]
Murthy, G. D.
(2003). The JNC 7 Hypertension Guidelines. JAMA
290: 1313-1313
[Full Text]
Ross, S., Macleod, M.-J.
(2003). Review: Hypertension in diabetes: a perspective from clinical pharmacology. British Journal of Diabetes & Vascular Disease
3: 252-256
[Abstract]
Mcinnes, G. T
(2003). `Size is not everything`: the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT): The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomised to angiotensin-converting enzyme inhibitor or calcium channel blocker versus diuretic. The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). British Journal of Diabetes & Vascular Disease
3: 263-267
[Abstract]
Goff, D. C. Jr.
(2003). The ALLHAT Study. Clin. Diabetes
21: 102-104
[Full Text]
Flack, J. M., Peters, R., Shafi, T., Alrefai, H., Nasser, S. A., Crook, E.
(2003). Prevention of Hypertension and Its Complications: Theoretical Basis and Guidelines for Treatment. J. Am. Soc. Nephrol.
14: S92-98
[Abstract][Full Text]
Patel, A., Chalmers, J., Chaturvedi, V., Currie, R., Monaghan, H., Neal, B.
(2003). Diabetes and Vascular Disease: a New International Trial. Asian Cardiovasc. Thorac. Ann.
11: 180-184
[Abstract][Full Text]
Wolf, G., Ritz, E.
(2003). Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management. J. Am. Soc. Nephrol.
14: 1396-1405
[Full Text]
Snow, V., Weiss, K. B., Mottur-Pilson, C., for the Clinical Efficacy Assessment Subcommittee,
(2003). The Evidence Base for Tight Blood Pressure Control in the Management of Type 2 Diabetes Mellitus. ANN INTERN MED
138: 587-592
[Abstract][Full Text]
Vijan, S., Hayward, R. A.
(2003). Treatment of Hypertension in Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice of Agents, and Setting Priorities in Diabetes Care. ANN INTERN MED
138: 593-602
[Abstract][Full Text]
Douglas, J. G., Bakris, G. L., Epstein, M., Ferdinand, K. C., Ferrario, C., Flack, J. M., Jamerson, K. A., Jones, W. E., Haywood, J., Maxey, R., Ofili, E. O., Saunders, E., Schiffrin, E. L., Sica, D. A., Sowers, J. R., Vidt, D. G., the Hypertension in African Americans Working Grou,
(2003). Management of High Blood Pressure in African Americans: Consensus Statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med
163: 525-541
[Full Text]
Staessen, J. A, Wang, J.-G., Birkenhager, W. H
(2003). Outcome beyond blood pressure control?. Eur Heart J
24: 504-514
[Full Text]
Katakura, M., Naka, M., Kondo, T., Nishii, N., Komatsu, M., Sato, Y., Yamauchi, K., Hiramatsu, K., Ikeda, M., Aizawa, T., Hashizume, K.
(2003). Prospective Analysis of Mortality, Morbidity, and Risk Factors in Elderly Diabetic Subjects: Nagano Study. Diabetes Care
26: 638-644
[Abstract][Full Text]
Mancia, G., Brown, M., Castaigne, A., de Leeuw, P., Palmer, C. R., Rosenthal, T., Wagener, G., Ruilope, L. M.
(2003). Outcomes With Nifedipine GITS or Co-Amilozide in Hypertensive Diabetics and Nondiabetics in Intervention as a Goal in Hypertension (INSIGHT). Hypertension
41: 431-436
[Abstract][Full Text]
Berlowitz, D. R., Ash, A. S., Hickey, E. C., Glickman, M., Friedman, R., Kader, B.
(2003). Hypertension Management in Patients With Diabetes: The need for more aggressive therapy. Diabetes Care
26: 355-359
[Abstract][Full Text]
Tuck, M. L.
(2003). Control of Hypertension in Diabetes. Diabetes Care
26: 534-535
[Full Text]
Mooradian, A. D.
(2003). Cardiovascular Disease in Type 2 Diabetes Mellitus: Current Management Guidelines. Arch Intern Med
163: 33-40
[Abstract][Full Text]
Laakso, M., Kuusisto, J.
(2003). Diabetology for cardiologists. Eur Heart J Suppl
5: B5-B13
[Abstract]
Fisher, M.
(2003). Prevention of macrovascular complications. Eur Heart J Suppl
5: B21-B26
[Abstract]
Sowers, J. R., Haffner, S.
(2002). Treatment of Cardiovascular and Renal Risk Factors in the Diabetic Hypertensive. Hypertension
40: 781-788
[Full Text]
Tong, P. C. Y., Lee, Z. S. K., Sea, M.-M., Chow, C.-C., Ko, G. T. C., Chan, W.-B., So, W.-Y., Ma, R. C. W., Ozaki, R., Woo, J., Cockram, C. S., Chan, J. C. N.
(2002). The Effect of Orlistat-Induced Weight Loss, Without Concomitant Hypocaloric Diet, on Cardiovascular Risk Factors and Insulin Sensitivity in Young Obese Chinese Subjects With or Without Type 2 Diabetes. Arch Intern Med
162: 2428-2435
[Abstract][Full Text]
Deferrari, G., Ravera, M., Deferrari, L., Vettoretti, S., Ratto, E., Parodi, D.
(2002). Renal and Cardiovascular Protection in Type 2 Diabetes Mellitus: Angiotensin II Receptor Blockers. J. Am. Soc. Nephrol.
13: S224-229
[Abstract][Full Text]
Swales, P., Williams, B.
(2002). Review: Calcium channel blockade in combination with angiotensin-converting enzyme inhibition or angiotensin II (AT1-receptor) antagonism in hypertensive diabetics and patients with renal disease and hypertension. Journal of Renin-Angiotensin-Aldosterone System
3: 79-89
[Abstract]
Beckman, J. A., Creager, M. A., Libby, P.
(2002). Diabetes and Atherosclerosis: Epidemiology, Pathophysiology, and Management. JAMA
287: 2570-2581
[Abstract][Full Text]
Elliott, H. L, McInnes, G. T
(2002). Special management needs of the elderly hypertensive patient. Journal of Renin-Angiotensin-Aldosterone System
3: S25-S31
Opie, L. H., Schall, R.
(2002). Evidence-based evaluation of calcium channel blockers for hypertension: Equality of mortality and cardiovascular risk relative to conventional therapy. J Am Coll Cardiol
39: 315-322
[Abstract][Full Text]
Elkeles, R. S, Flather, M., Feher, M. D, Godsland, I., Richmond, W., Humphries, S. E, Rubens, M. B, Underwood, S R.
(2002). Prospective evaluation of diabetic ischaemic heart disease by computed tomography: the PREDICT study. British Journal of Diabetes & Vascular Disease
2: 69-72a
[Abstract]
Arauz-Pacheco, C., Parrott, M. A., Raskin, P.
(2002). The Treatment of Hypertension in Adult Patients With Diabetes. Diabetes Care
25: 134-147
[Full Text]
Kaplan, N. M.
(2001). Management of Hypertension in Patients with Type 2 Diabetes Mellitus: Guidelines Based on Current Evidence. ANN INTERN MED
135: 1079-1083
[Abstract][Full Text]
Bakris, G. L.
(2001). A Practical Approach to Achieving Recommended Blood Pressure Goals in Diabetic Patients. Arch Intern Med
161: 2661-2667
[Abstract][Full Text]
Niskanen, L., Hedner, T., Hansson, L., Lanke, J., Niklason, A.
(2001). Reduced Cardiovascular Morbidity and Mortality in Hypertensive Diabetic Patients on First-Line Therapy With an ACE Inhibitor Compared With a Diuretic/{beta}-Blocker-Based Treatment Regimen: A subanalysis of the Captopril Prevention Project. Diabetes Care
24: 2091-2096
[Abstract][Full Text]
Eriksson, J., Lindstrom, J., Tuomilehto, J.
(2001). Potential for the prevention of type 2 diabetes. Br Med Bull
60: 183-199
[Full Text]
Lewis, E. J., Hunsicker, L. G., Clarke, W. R., Berl, T., Pohl, M. A., Lewis, J. B., Ritz, E., Atkins, R. C., Rohde, R., Raz, I., the Collaborative Study Group,
(2001). Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes. NEJM
345: 851-860
[Abstract][Full Text]
Ruilope, L. M., Schiffrin, E. L.
(2001). Blood Pressure Control and Benefits of Antihypertensive Therapy: Does It Make a Difference Which Agents We Use?. Hypertension
38: 537-542
[Abstract][Full Text]
Zanella, M. T., Kohlmann, O. Jr, Ribeiro, A. B.
(2001). Treatment of Obesity Hypertension and Diabetes Syndrome. Hypertension
38: 705-708
[Abstract][Full Text]
Vinik, A. I., Erbas, T., Park, T. S., Stansberry, K. B., Scanelli, J. A., Pittenger, G. L.
(2001). Dermal Neurovascular Dysfunction in Type 2 Diabetes. Diabetes Care
24: 1468-1475
[Abstract][Full Text]
Elliott, M. D., Kapoor, A., Parker, M. A., Kaufman, D. B., Bonow, R. O., Gheorghiade, M.
(2001). Improvement in Hypertension in Patients With Diabetes Mellitus After Kidney/Pancreas Transplantation. Circulation
104: 563-569
[Abstract][Full Text]
Cleophas, T. J., van Ouwerkerk, B. M., van der Meulen, J., Zwinderman, A. H.
(2001). Diabetics with Hypertension Not Controlled with ACE Inhibitors: Alternate Therapies. ANGIOLOGY
52: 469-475
[Abstract]
Epstein, M., Black, H. R.
(2001). Arterial Calcification and Calcium Antagonists : What Does It Mean?. Hypertension
37: 1414-1415
[Full Text]
Kizer, J. R., Kimmel, S. E.
(2001). Epidemiologic Review of the Calcium Channel Blocker Drugs: An Up-to-date Perspective on the Proposed Hazards. Arch Intern Med
161: 1145-1158
[Abstract][Full Text]
Foggensteiner, L., Mulroy, S., Firth, J.
(2001). Management of diabetic nephropathy. JRSM
94: 210-217
[Full Text]
Brown, M.J., Palmer, C.R., Castaigne, A., de Leeuw, P.W., Mancia, G., Rosenthal, T., Ruilope, L.M.
(2001). Principal results from the international nifedipine GITS study: Intervention as a goal in hypertension treatment (INSIGHT). Eur Heart J Suppl
3: B20-B26
[Abstract]
Barzilay, J. I., Jones, C. L., Davis, B. R., Basile, J. N., Goff, D. C. Jr., Ciocon, J. O., Sweeney, M. E., Randall, O. S.
(2001). Baseline Characteristics of the Diabetic Participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Diabetes Care
24: 654-658
[Abstract][Full Text]
Sowers, J. R., Epstein, M., Frohlich, E. D.
(2001). Diabetes, Hypertension, and Cardiovascular Disease : An Update. Hypertension
37: 1053-1059
[Abstract][Full Text]
Kaplan, N. M, Josefson, D., Cockcroft, J R, Wilkinson, I B
(2001). Inferiority of calcium channel blockers to cheaper drugs. BMJ
322: 671a-671
[Full Text]
Bulpitt, C. J
(2001). Review: The management of the elderly with hypertension. Journal of Renin-Angiotensin-Aldosterone System
2: 11-13
Meneilly, G. S., Tessier, D.
(2001). Diabetes in Elderly Adults. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
56: 5M-13
[Abstract][Full Text]
Grimm, R. H. Jr, Margolis, K. L., Papademetriou, V., Cushman, W. C., Ford, C. E., Bettencourt, J., Alderman, M. H., Basile, J. N., Black, H. R., DeQuattro, V., Eckfeldt, J., Hawkins, C. M., Perry, H. M. Jr, Proschan, M.
(2001). Baseline Characteristics of Participants in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension
37: 19-27
[Abstract][Full Text]
Opie, L. H.
(2000). First line drugs in chronic stable effort angina--the case for newer, longer-acting calcium channel blocking agents. J Am Coll Cardiol
36: 1967-1971
[Abstract][Full Text]
McGuire, D.K, Emanuelsson, H, Granger, C.B, Magnus Ohman, E, Moliterno, D.J, White, H.D, Ardissino, D, Box, J.W, Califf, R.M, Topol, E.J
(2000). Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes. Findings from the GUSTO-IIb Study. Eur Heart J
21: 1750-1758
[Abstract]
Grossman, E., Messerli, F. H., Goldbourt, U.
(2000). High Blood Pressure and Diabetes Mellitus: Are All Antihypertensive Drugs Created Equal?. Arch Intern Med
160: 2447-2452
[Abstract][Full Text]
Mogensen, C. E.
(2000). ACE inhibitors and antihypertensive treatment in diabetes: focus on microalbuminuria and macrovascular disease. Journal of Renin-Angiotensin-Aldosterone System
1: 234-239
Tuomilehto, J.
(2000). Controlling glucose and blood pressure in type 2 diabetes. BMJ
321: 394-395
[Full Text]
60 years) with systolic blood pressure of 160 to 219 mm Hg and diastolic pressure below 95 mm Hg were randomly assigned to receive active treatment or placebo. Active treatment consisted of nitrendipine (10 to 40 mg per day) with the possible addition or substitution of enalapril (5 to 20 mg per day) or hydrochlorothiazide (12.5 to 25 mg per day) or both, titrated to reduce the systolic blood pressure by at least 20 mm Hg and to less than 150 mm Hg. In the control group, matching placebo tablets were administered similarly. 
Previous
