1. Type 2 diabetes and high blood pressure How explosive is the cocktail?

2. Type 2 diabetes and high blood pressure - How explosive is the cocktail? -
Epidemiology of type 2 diabetes and hypertension II
Risks for hypertensive patients with diabetes
III
Guidelines position

3. Two diabetic patients out of three also suffer from hypertension
Worldwide epidemiology
1 billion hypertensive patients
387 million patients with type 2 diabetes
258 million hypertensive patients with type 2 diabetes
WHO IDF 2015.
Ferrannini E, Cushman WC. Lancet. 2012;380(9841):

4. Cardiovascular disease event
Excess cardiovascular risk in diabetic patients is attributable to coexistent hypertension
“Participants with hypertension at the time of diabetes diagnosis had higher rates of all-cause mortality and cardiovascular disease than did people with diabetes without hypertension”
All-cause mortality
+72%
Cardiovascular disease event
+57%
Ferrannini E, Cushman WC. Lancet. 2012;380(9841):

5. Reduce mortality rate in patients with diabetes remains an important challenge
Type 2 diabetes increases mortality risk by two-fold, macrovascular disease is the predominant cause of death
Type 2 diabetes is associated with twice higher risk of MI and 1.5 higher risk of stroke
Nwaneri C et al. Br J Diabetes Vasc Dis. 2013;13: Gregg EW et al. N Engl J Med. 2014;370(16):

6. Early control of blood pressure in hypertensive diabetic patients is essential to avoid early risk
A diabetic patient whose blood pressure is not controlled within a year after hypertension onset has a 30% increased risk of CV events at 3 years
CV = Cardiovascular, MI = myocardial infarction Retrospective cohort. n= hypertensive diabetic patients without coronary disease and without a history of stroke. Adjusted incidence RRs for stroke, myocardial infarction, and other major cardiovascular events were estimated based on the mean level of BP control in the year after onset of hypertension. O’Connor PJ et al. Diabetes Care. 2013;36(2):

7. The 2013 ESH/ESC guidelines recommend a target BP of 140/85 mm Hg

8. The early initiation of a antihypertensive treatment and the use of multiple therapy at high doses are favored by the ADA guidelines