(Circulation. 2001;104:508.)
© 2001 American Heart Association, Inc.
Editorial |
Who’s on First?
Does Hypertension in Type I Diabetics Result From Nephropathy or Metabolic Alterations?
From the Department of Medicine (M.S.R.) and the Division of Cardiology (A.L.H.), University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
Correspondence to Alan L. Hinderliter, MD, Division of Cardiology, University of North Carolina, CB #7075, 338 Burnett-Womack, Chapel Hill, NC, 27599-7075 (E-mail hinderli@med.unc.edu) or to Marschall S. Runge, MD, PhD, Chair, Department of Medicine, University of North Carolina, CB #7005, Room 3033, Chapel Hill, NC 27599-7005 (E-mail mrunge@med.unc.edu).
Key Words: Editorials • hypertension • diabetes mellitus
It has long been assumed that end-organ damage by the metabolic abnormalities associated with type I diabetes mellitus occurs before clinically evident adverse outcomes. However, the study reported by Elliott et al1 in the present issue of Circulation suggests that it is time to reconsider this hypothesis.
See p 563
Patients with diabetes mellitus are at a high risk of cardiovascular events. Observational studies suggest that cardiovascular morbidity is 
2 times higher in diabetics than in the general population, and that cardiovascular disease accounts for 70% of all deaths in people with diabetes mellitus.2,3 The risk of vascular events is further heightened by coexistent hypertension. As in the general population, there is a strong, graded relationship between hypertension and coronary heart disease and stroke in diabetic patients, independent of other traditional risk factors.4 In diabetics, as in nondiabetics, most studies focus on the treatment of hypertension as a surrogate end point for cardiac risk reduction.
Treatment of Hypertension in Patients With Diabetes Mellitus
Acknowledgment of the excessive risk of cardiovascular events in patients with diabetes and hypertension has led to numerous studies on the potential benefits of optimizing antihypertensive therapy in this population. The results of several recent clinical trials demonstrate that rigorous control of arterial pressure in patients with diabetes markedly reduces morbidity and mortality from cardiovascular disease. In the Hypertension Optimal Treatment (HOT) trial, hypertensive patients were randomized to 1 of 3 diastolic blood pressure targets: 
90 mm Hg, 85 mm Hg, or 80 mm Hg. Initial therapy was with felodipine, and an ACE inhibitor or
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Circulation 2001 104: 563-569.