The answer surprised me. Clearly type 1 need to control BG with insulin. But for those of us with type 2,these folks believe blood pressure control is more important
--G
Treatment of Hypertension in Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice of Agents, and Setting Priorities in Diabetes Care -- Vijan and Hayward 138 (7): 593 -- Annals of Internal Medicine
"The dramatic effects of hypertension treatment in diabetes are striking and raise an important question: Where should diabetes treatment priorities lie? Because diabetes is defined by glucose levels, much of the emphasis in diabetes care has been on optimal blood glucose control. However, glucose control is clearly effective only in reducing microvascular end points, and to date only intermediate outcomes have been shown to be reduced. For example, the UKPDS showed that glycemic control reduced progression of retinopathy and photocoagulation, but after 10 years of follow-up, visual acuity, renal function, functional status, and mortality rates were not significantly improved (..). In contrast, control of hypertension is dramatically effective in reducing risk for cardiovascular events and mortality and does so within a 4- to 6-year period (...). Furthermore, hypertension control appears to be more effective than glycemic control in reducing microvascular events (...). We do not intend to suggest that glycemic control is an ineffective intervention (...), but rather that treatment of hypertension should be prioritized and stressed as the most important intervention for the average population of persons with type 2 diabetes. Blood pressure targets should be 135/80 mm Hg. First-choice agents should probably be thiazide diuretics, angiotensin II receptor blockers, or ACE inhibitors, and second-choice agents should be ß-blockers or calcium-channel blockers.
Aggressive control of blood pressure in patients with type 2 diabetes has dramatic benefits and should be the first priority in diabetes care.
