Current Issues in Treating the Hypertensive Patient with Diabetes: Focus on Diabetic Nephropathy

OBJECTIVE:To review the pathophysiology of hypertension and complications in patients with diabetes mellitus, specifically focusing on diabetic nephropathy; to evaluate the current clinical literature regarding the appropriate management of hypertension in this patient group; and to offer treatment recommendatiDATA SOURCES:A MEDLINE search of applicable English-language clinical studies, abstracts, and review articles pertaining to hypertension, diabetes, and diabetic nephropathy.STUDY SELECTION:Relevant studies on humans, examining hypertension, diabetes, and diabetic nephropathy, and the effects of drug therapy on these interrelated disease states.DATA SYNTHESIS:Pathophysiology of hypertension in the patient with diabetes mellitus and the pathophysiology of diabetic nephropathy are discussed. Studies evaluating the therapeutic effect of certain antihypertensive agents, their effect on glucose control and insulin sensitivity, and the progression of diabetic nephropathy are reviewed. Recommendations on the treatment of the patient with diabetes and hypertension are given.CONCLUSIONS:The treatment of the patient with diabetes mellitus and hypertension remains complex. Interventions in this patient population should not only decrease blood pressure, but also reduce the risk of both vascular and nonvascular complications. Data support the theory that by controlling a patient's hypertension, the incidence of albuminuria and the progression of diabetic nephropathy are slowed. Additionally, data are available to support the use of pharmacologic interventions in nonhypertensive patients with diabetes and proteinuria. Drug therapies that have produced reductions in proteinuria in this patient population include angiotension-converting enzyme inhibitors and nondihydropyridine calcium-channel antagonists. Additional information is needed to better differentiate the individual agents within each of the antihypertensive drug classes regarding their individual effects on the patient with diabetes and hypertension, specifically effects on diabetic nephropathy and its progression to endstage renal disease.</jats:sec

Abstract 1189: Changes in the Prevalence of Abnormal Lipid Fractions among US Adults: Results from the National Health and Nutrition Examination Survey II, III, and 1999–2006

Objective To examine the prevalence of abnormal lipid fractions among US adults from 1976 through 2006, with a focus on the relationship of dyslipidemia and obesity. Methods Adults aged 20 to 74 years who took the blood lipid examination were selected from the National Health and Nutrition Examination Surveys (NHANES): NHANES II (1976 –1980), NHANES III (1988 –1994), and NHANES 1999 –2006. Obesity was defined as BMI ≥ 30 kg/m 2 . Dyslipidemia was defined as presence of one or more abnormal lipid fractions: low density lipoprotein cholesterol (LDL-C) ≥ 100 mg/dL, high density lipoprotein cholesterol (HDL-C) &lt; 40 mg/dL, and triglycerides (TG) ≥ 150 mg/dL. Crude and age-stratified proportions of abnormal lipid fractions for US adults and for those with obesity were estimated. Multivariate analysis was used to assess the association between dyslipidemia and obesity, controlling for age, gender, race/ethnicity, NHANES wave, and comorbidities (heart attack, diabetes and smoking status). Results The prevalence of abnormal LDL-C decreased from 43.5% in NHANES II to 36.3% in NHANES 1999–2006; however, during this period, the prevalence of abnormal TG and HDL-C combined doubled from 2.1% to 4.8% and the abnormal TG more than tripled within the elderly population (from 1.8% to 11.3%). It was estimated that antidyslipidemic medication use was less than 2.6% for adults with dyslipidemia throughout study period. With the increased prevalence of obesity between NHANES II and NHANES 1999 –2006, the prevalence of abnormal TG and HDL-C combined increased from 3.8% in NHANES II to 6.5% in NHANES 1999 –2006 within obese adults. Multivariate analyses of BMI with dyslipidemia were significant (p&lt; 0.001). Adults with obesity were more likely to have dyslipidemia than those with BMI &lt; 25 kg/m 2 [OR=2.9, (95% CI: 2.7–3.2)]. Conclusions Prevalence of abnormal TG and/or HDL-C increased between NHANES II and NHANES 1999–2006 although the abnormal LDL-C shows an optimistic trend. This was paralleled by a shift in the distribution of BMI toward the obese category. As the US population is aging and becoming more obese, this analysis underscores the need for renewed public health efforts with focus on treating multiple abnormal lipid fractions and preventing dyslipidemia via body mass control. <jats:p /