I previously posted a note stating that the HOT study appeared to indicate
that hypertensive patients with diabetes should have their diastolic BP
targeted to < 80. Postings to the list have made me reconsider whether that
is the correct conclusion.
On 9-2-98, Rod Jackson wrote:
>>>>>>>>>
>> Joe - I am not sure how HOT lifts the shadow off Ca blockers because
>>everyone in the study got them. One would need to undertake a study with a
>>comparison group either taking a placebo or a drug which has been shown to
>>be better than placebo (eg diuretics or beta blockers) and show that ca
>>blockers were equally or more effective in reducing CVD events. The
>>relatively low CVD event rates in the participants overall tells us nothing
>>about the drug effects. Despite the high pretreatment blood pressures,
>>many patients came from low CVD risk population.
>>
>>Rod Jackson
In light of other studies suggesting improved outcomes in diabetic patients
treated with calcium channel blockers--especially when compared with ACE
inhibitors, I re-examined the details of the HOT study groups. As expected,
the groups assigned to lower target diastolic BP more commonly used ACE
inhibitors--shown previously to be associated with better outcomes in diabetic
patients, beta blockers, and diuretics. An alternative--equally if not more
likely--explanation for the improved outcomes in diabetics assigned to lower
target BP's is that those patients more commonly used ACE inhibitors, beta
blockers, and diuretics. It may not be the lower BP that yielded benefit, but
the agents used in the HOT study to achieve the lower BP.
Pending results of further studies--such as final results of the ABCD
trial, I no longer plan to alter my current approach to treating hypertensive
diabetic patients. I will still target the diastolic BP to be lower than 90,
but will continue to rely on ACE inhibitors, beta blockers, and diuretics as
the main groups of antihypertensive agents I will prescribe. I will continue,
in general, to avoid calcium channel blockers to lower BP.
Cheers and Best Wishes,
Brian
...................................................................
Brian Budenholzer, MD
Director, Clinical Enhancement & Development
Group Health Northwest
CC16
PO Box 204
Spokane, WA 99210-0204
USA
[log in to unmask]
509/ 838-9100 X 7393
fax: 509/ 458-0368
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