[georgepds]

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.

[princesslinda]

Interesting. My doc told me as a diabetic he wanted my BP UNDER 120/80 at all times. Said anything over that could be bad for my kidneys and I didn't need two strikes against me as I already had diabetes. I'm on HCTZ and Enalapril.

My dad, age 66, is not diabetic, and wasn't given as strict of a BP goal as I was. Maybe age has something to do with it as well?

[xMenace]

Of course BP is more important. You can live decades with moderate BG control, albiet at an increasingly less pleasant pace. High BP can take you out now.

My understanding is they are mutually exclusive. You don't have to sacrifice one for the other.

Low BG also helps to keep BP low

[fgummett]

The Clinical Practice Guidelines here in Canada set lower acceptable levels on BP (tighter control) for those of us with D

[ShottleBop]

I found that controlling my blood sugars brought my BP down. (Of course, it could have been weight loss, as well.)

[georgepds]

Very interesting, and worth a detailed read. Burried on table 2 was the gem that 'for stroke intensive glucose control led to a trend toward harm rather than benefit"

Now I've got to figure out at what level. Any of you UKPDS experts know what "intensive glucose control" meqans in tthis context.

[BriOnH]

Originally Posted by xMenace

My understanding is they are mutually exclusive. You don't have to sacrifice one for the other.

Totally. They both are equally important imo. High blood pressure and high BGL is SO bad on the body. If you have both it can cause a lot of necrosis by pushing sugary blood (think of the 4th grade nail in the coke can experiment) very forcefully through your organs. If you put a nail in a coke can and constantly shake it (pv=nrt boyles law) it will increase pressure and eat that nail to nothing waaaaay faster. Same goes for our bodies.

High BG * High BP = high rate of necrosis

[Evermont]

This reinforces the idea that good nutrition and exercise matters for everyone. That meds or insulin which help with BG are not a license to slack or skip exercise, or ignore healthy eating. When our BG control is built on a foundation of diet and exercise (adding meds as needed) we are also improving BP. If we rely on meds for BG control we can, and probably often do, backslide on the basics exposing BP which can be as bad or now apparently worse. Of course there are meds for BP too...

[Scrabblechick]

And I'm on meds for both. LOL. My BP has been pretty good the past several months. Let's see what it looks like at my next endo visit.

BG hasn't been bad, either.

[Aslosman]

Originally Posted by Evermont

This reinforces the idea that good nutrition and exercise matters for everyone. That meds or insulin which help with BG are not a license to slack or skip exercise, or ignore healthy eating.

Curses, foiled again!

[georgepds]

Originally Posted by princesslinda

Interesting. My doc told me as a diabetic he wanted my BP UNDER 120/80 at all times. Said anything over that could be bad for my kidneys and I didn't need two strikes against me as I already had diabetes. ...

My dad, age 66, is not diabetic, and wasn't given as strict of a BP goal as I was. Maybe age has something to do with it as well?

Age definitely has something to do with it. Take a look at slide 4 here ( you need to register, it's free)

www medscape com/viewprogram/3599_pnt

If you are 80-89 your mortality risk is 64x greater than a person in the 40-49 age group ( even at a BP of 120/80)

So, the first rule is don't get old. For those of us who are non compliant and can just not resist adding on all those extra years, the best you can do is keep your blood pressure low.

[-sammy-]

both are important. when i have high sugars i have high blood preasure aswell. i even went on a 24hr blood presure monitor to see.
but it does depend on the person you are

[georgepds]

Originally Posted by -sammy-

both are important. when i have high sugars i have high blood preasure aswell. i even went on a 24hr blood presure monitor to see.
but it does depend on the person you are

Yes they are, and yes it does, but let me spell it out: BP control is more important.. The UKPDS study showed that with strict blood glucose control "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"

So, sure the BG control is important... but if you really want to (increase your chance to) be alive ten years from now.. get the BP under control

[-sammy-]

yeah ok defo. but i was saying it for the type 1's too. but i understand with type 2's its a little different with blood presure. thts ok. but yeh its still important

[georgepds]

Originally Posted by -sammy-

yeah ok defo. but i was saying it for the type 1's too. but i understand with type 2's its a little different with blood presure. thts ok. but yeh its still important

Yes, for type 1 it is a different situation, my remarks are for type 2