gms | German Medical Science

Background: The beneficial effects on microalbumiuria and vascular outcome parameters of tight control of hyperglycemia and blood pressure in hypertensive patients with type 2 diabetes mellitus are beyond doubt. Tight control of hyperlipidemia and the use of aspirin are also commonly recommended. Therefore, there was hope that in daily practice, global risk management in hypertensive type 2 diabetic patients might also improve.

Methods: Evaluation of clinical characteristics and pre-existing therapy in 105 Type 2 diabetic patients referred to our hospital in 2004 by their general practitioners for initiation or optimization of insulin treatment.

Results: Mean age was 63 ± 12 (average ± SE). HbA1c was 8.7 ± 1.7 % before intervention in our hospital. 82 % of the patients had hypertension (BP > 140/90 mmHg or antihypertensive treatment), 52 % of these had increased albuminuria (UAE), 15 % had no antihypertensive treatment. Although treated patients received 2.4 ± 1.2 antihypertensive drugs, blood pressure averaged 146 ± 20/82 ± 14 mmHg in patients with increased UAE in contrast to 113 ± 15/77 ± 11 mmHg in normoalbuminuric patients, p < 0,01). 81 % of the patients with increased UAE had ACE inhibitors, but only 20 % received any lipid lowering therapy and 38 % had aspirin, in contrast to 58 %, 32 % and 51 %, respectively, in hypertensive patients with normal UAE, p < 0,01, despite greatly increased lipid levels.

Conclusions: Despite the clear recommendations in the current guidelines and disease management programs for type 2 diabetes mellitus, there is no efficient global risk management in hypertensive type 2 diabetic patients in daily practice. Particularly in patients with increased UAE our results are disappointing. ACE inhibitors exhibit their well-documented nephroprotective action only in patients with controlled hypertension. The rate of patients receiving aspirin and/or lipid lowering treatment drugs must be improved