Newly diagnosed diabetics have a while to lower BP without medication
MedWire News: Individuals with newly diagnosed diabetes and hypertension may have up to a year to try lowering their blood pressure through lifestyle modification before having to resort to antihypertensive medication, shows a US study.
The findings suggest that multiple years of delay in controlling systolic blood pressure may lead to significant declines in health outcomes in the diabetic population, 1-year delays are expected to lead to only small declines.
Current guidelines recommend that diabetes patients undergo a maximum of 3 months of medication-free lifestyle therapy to see if they can reduce their blood pressure without having to initiate antihypertensive medication.
However, the current study suggests they have more time - at least up to a year - to adapt to diabetes self-management and lifestyle modification.
"Our results indicate that it's okay to spend from 6 months to a year, perhaps even longer, to make the difficult lifestyle changes that are necessary and will pay off in the long run," said lead author Neda Laiteerapong (University of Chicago, Illinois) in a press statement.
The team used computer models based on diabetes complication equations from the UK Prospective Diabetes Study to estimate the magnitude of harm caused by different periods of delay among a hypothetical population of adults, aged 50 to 59 years, with newly diagnosed Type 2 diabetes.
They compared complication rates in a population who had a lifetime of controlled systolic blood pressure (130 mmHg) with populations who delay lowering systolic blood pressure from 150 to 130 mmHg.
The complications assessed included amputation, congestive heart failure, end-stage renal disease, ischemic heart disease, myocardial infarction, and stroke.
The researchers found that a lifetime of uncontrolled systolic blood pressure (the maximum expected harm of delays) increased complications by 1855 events per 10,000 patients and decreased average quality-adjusted life expectancy (QALE) by 332 days.
A 10-year delay in controlling systolic blood pressure increased complications by 428 events per 10,000 patients and decreased QALE by 145 days.
However, a 1-year delay only increased complications by 14 events per 10,000 patients and decreased QALE by 2 days.
"Many patients would prefer to control blood pressure through diet and exercise rather than with antihypertensive medications," writes the team in the Journal of General Internal Medicine. "It's important to do this right, but our results say it's not that important to do it so fast," said Laiteerapong.
"Discussions with patients about initiating intensive blood pressure control could be enhanced by including information on how postponing blood pressure control can affect their lifelong outcomes," suggest the researchers.
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Sally Robertson