Blood pressure in type 2 diabetes

Blood pressure (BP) control is a critical part of managing patients with type 2 diabetes. Perhaps it is the single most important aspect of diabetes care, which unlike hyperglycemia and dyslipidemia can reduce both micro- and macrovascular complications. Hypertension is more prevalent in individuals with diabetes than general population, and in most cases its treatment requires two or more pharmacological agents (about 30% of individuals with diabetes need 3 or more medications to control BP).

In this article we describe the key evidence that has contributed to our understanding that reduced BP translates into positive micro- and macrovascular outcomes. We review the data supporting current recommendation for BP target < 130/80 mmHg. Two studies suggest that a lower BP goal could be even more beneficial. We also present the comparative benefits of various antihypertensive drugs in reducing diabetes-related micro- and macrovascular complications.

Finally we propose an evidence-based algorithm of how to initiate and titrate antihypertensive pharmacotherapy in affected individuals. Overall, achieving BP < 130/80 mmHg is more important than searching for the “best” antihypertensive agent in patients with diabetes.


Victoza vs. Byetta in type 2 diabetes

In LEAD-6 trial, about 500 patients with type 2 diabetes were followed for 26 weeks. Participants were randomized to receive either Victoza 1.8 mg once daily or Byetta 10 mcg twice daily. Results indicated relative superiority of Victoza over Byetta as shown by improved A1c (-Δ1.1% vs -Δ0.8%) and better convenience and tolerability.