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04-04-2013 | Metabolism | Article

Calcium channel blockers best for managing hypertension in diabetes

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medwireNews: Calcium channel blockers (CCB) stabilize morning blood pressure variability to a greater extent than other antihypertensive medications in patients with hypertension and Type 2 diabetes, suggest study findings.

In addition to reducing the risk for cardiovascular events, "strict control of blood pressure…at home…is important for the prevention of development and progression of microvascular and macrovascular complications in patients with type 2 diabetes," say Michiaki Fukui (Kyoto Prefectural University of Medicine, Japan) and colleagues.

Angiotensin II receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACE-I) are recommended as first-line therapy for hypertensive patients with Type 2 diabetes. However, the researchers say that no previous studies have investigated the relationship between antihypertensive drug class and home blood pressure variability (HBPV) in this patient population.

HBPV was compared among Type 2 diabetes patients treated with calcium channel blockers (n=44), ARB or ACE-I (n=159), or CCB combined with ARB and/or ACE-I (n=183).

The researchers found that the coefficient variation of morning systolic blood pressure, or HBPV, in patients treated with CCB was significantly lower than that for patients treatments with ARB and/or ACE-I (a mean of 6.59 vs 7.45).

Furthermore, significant positive relationships were seen between HBPV and duration of diabetes mellitus or average morning systolic blood pressure.

Multiple regression analysis confirmed the findings, showing that average morning systolic blood pressure and CCB treatment significantly correlated with HBPV independent of other potential cofactors, including timing of antihypertensive therapy.

Fukui and team say the findings are consistent with previous evidence in hypertensive patients. They note that although it is unclear how CCB decreases BPV, it is possible that since BPV is controlled partly by the arterial baroreflex, CCB's effect on BPV could be mediated by improved baroreflex function.

"Although ARB or ACE-I is recommended to be prescribed as a first line treatment for hypertensive patients with type 2 diabetes... CCB is more beneficial…from the point of view of reducing HBPV," conclude the researchers.

They call for further studies and intervention trials to confirm a causal relationship between antihypertensive drug class and HBPV in patients with Type 2 diabetes.

By Ingrid Grasmo, medwireNews Reporter

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