gms | German Medical Science

Regrettably, type II diabetes (d.m. 2) is often not diagnosed before the onset of secondary angiopathic complications such as neuropathy, retinopathy or even myocardial or cerebral infarction. Several studies have shown that manifest d.m. 2 is preceded by a state with "impaired fasting glucose" (IFG) or impaired glucose tolerance (IGT).

A majority of patients (pts) with IFG or IGT simultaneously suffers from hypertension, which leads to a further increase in the risk for vascular diseases. For this group, the German Hypertension League recommends the same strict blood pressure limits (max 130/80 mmHg) as for hypertensives with manifest d.m. 2.

Results of the HOPE study have shown that in pts with high cardiovascular risk that were treated with 10mg/d ramipril, the incidence of d.m.2 was reduced by 34%. This and other study results suggest that ACE inhibitors may be able to prevent or at least to delay the onset of manifest d.m.2 in hypertensive pats with IGF. In contrast due to the results of the ALLHAT study, diuretics are recommended as the first step of antihypertensive therapy by several international guidelines.

The ADaPT project , an open, prospective, multi-center observation of pre-diabetic hypertensives, was initiated in cooperation with the German Hypertension League to compare ramipril as the primary antihypertensive drug (group A) vs diuretic/ß-blocker based treatment (group B). 2,000 pts (1333 group A/667 group B) will be included. Inclusion criteria are hypertension (>=140/90 mmHg), IFG (fg 6,1-7,0mmol/l) and age >54 yrs. Main exclusion criteria are manifest dm (i.e. fg> 7,0 mmol/l or HbA1c>6,5%), renal insufficiency, MI, and cerebral infarction.

Pts will be observed for 4 yrs. In addition to regular office bp and ABP measurements, concomitant medication and waist-to-hip ratio are recorded. Relevant laboratory values are determined once a year centrally.