Introduction: Cardiovascular risk in patients with type 2 diabetes mellitus (DM) and arterial hypertension (HTN) is 75% greater than in those without HTN. Antihypertensive therapy, mainly based on angiotensin-converting enzyme inhibitors (ACEI), calcium channel blockers (CCB) and diuretics, has individualized thera-peutic targets. Fixed combinations of drugs are strongly recommended for optimizing patient adherence.
Objective: The aim of this retrospective study was the analysis of antihypertensive treatment in patients with both DM and HTN in everyday clinical practice, with respect to DM complications, blood pressure (BP) and DM control, rehospitalizations and all-cause mortality.
Methods: The study included 156 consecutive inpatients with type 2 DM and HTN, with a mean age of 66.7 years, 46.5% of which were men, followed for 2 years regarding antihypertensive therapy (drug classes, fixed combinations), DM (A1c hemoglobin, fasting plasma glucose) and HTN control, rehospitalizations for cardiovascular disease and death from any cause. The patients were divided into two groups (G): G1 with uncomplicated DM (62 patients, 39.7%) and G2 with complicated DM (94 patients, 60.3%). A1c hemoglobin has been documented in 89 patients (57%).
Results: There were 1.7 complications/patient in G2 (64.9% diabetic nephropathy and 60.6% neuropathy). The mean number of drug classes was higher in G2 (3.6 vs. 3.2 in G1, p= 0.028). 15 (9.6%) of patients were on fixed combinations. BP was controlled in 57.3% of patients, while DM in 50% of patients. 91 (58%) pati-ents were readmitted for heart failure decompensation (62.4%), arrhythmias (31.8%) or ischemic heart disea-se (15.95%). The number of drug classes was associa-ted with the number of rehospitalizations (p= 0.012). Treatment was changed in 33% patients on readmissi-on, while fixed combinations were given to 5 patients (5%). BP on the last admission was controlled in 46.2% of patients, while DM in 45.8% of patients. 2-year mortality was 12.2% and was associated with complicated DM (p= 0.0054).
Conclusions: A significant proportion of patients, approximately half, had an inefficient long term control for both diabetes mellitus and arterial hypertension, associated with increased mortality, especially in patients with complicated diabetes mellitus, and frequent readmissions, mostly by heart failure. Hypertensive diabetics required a higher number of antihypertensive drug classes, particularly inhibitors of the renin-angiotensin system and calcium channel blockers. A better blood pressure control could be achieved by starting treatment early before complications occur, by reducing the inertia in changing therapy and by increasing the use of fixed combinations of drugs.