National Kidney Foundation Urges Aggressive Treatment of Diabetics with High Blood Pressure

New York, NY
August 29, 2000

The National Kidney Foundation (NKF) today announced the release of new treatment recommendations for patients with both high blood pressure and diabetes. The NKF’s recommendations, published in the September edition of the American Journal of Kidney Diseases, address what it regards as the hidden public health crisis caused by diabetes and high blood pressure. More than 11 million Americans suffer from both conditions, which, if left untreated, can lead to heart attacks, strokes and kidney failure. Kidney failure contributes to the deaths of approximately 58,000 people each year.

“Undetected or inadequately treated high blood pressure is a serious condition that can lead to kidney failure and premature death,” said William Keane, MD, president-elect of the National Kidney Foundation. “Despite the severity of this problem, patients and families are largely unaware of the dangers of this condition. With these recommendations, the NKF is giving physicians the tools they need to provide informed and state-of-the-art treatment to this patient population, while drawing much-needed attention to the problem of diabetes and hypertension.”

New Goal Blood Pressure

To avoid the complications associated with high blood pressure and diabetes, the NKF is urging physicians to lower the blood pressure of patients with both conditions to <130/80 millimeters of mercury (mmHg). This is an improvement over the previous standard of 130/85 mmHg, recommended in 1997 in the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure issued by the National Institutes of Health (NIH).

This new diastolic blood pressure goal-the lower number on the blood pressure reading-is the level needed to preserve optimal kidney function and prevent strokes and heart attacks in individuals whose kidneys have been damaged by diabetes. Diastolic blood pressure measures the force exerted by the blood on the arteries as the heart relaxes.

Drug Therapy

The NKF’s recommendations for physicians focus primarily on drug therapy for diabetic patients with high blood pressure. They include the following:

  • Begin therapy with drugs (ACE inhibitors) that block the production of angiotensin II, a chemical that causes blood vessels to contract. The dose of the medication should be increased, as needed to the moderate or high-dose range, depending on side effects
  • If target blood pressure is not reached, add agents, such as diuretics, that lower blood pressure by eliminating excess water and salt from the body or drugs such as calcium channel blockers (CCBs) that slow the heart rate and relax blood vessels
  • Switch to a single-dose multi-drug combination of an ACE inhibitor/diuretic or an ACE inhibitor/CCB after blood pressure is controlled. These formulations help contain medication costs and reduce the amount of pills a patient must take each day

Combination Therapy Needed for Most Diabetic Patients with High Blood Pressure

While these recommendations regarding multi-drug therapy represent a significant shift from standard hypertension management strategies, recent research indicates that it is highly unlikely that health care professionals will be able to attain these new lower blood pressure goals using one drug.

"Data from several major recent clinical trials demonstrate that patients require an average of more than three different antihypertensive medications to reach lower blood pressure goals," said George Bakris, MD, Vice-Chairman, Department of Preventive Medicine and Director, Hypertension/Clinical Research Center, Rush-Presbyterian-St. Luke's Medical Center and the lead author of the report. "Physicians must be willing to shift to more flexible pharmacological treatment strategies if we are to achieve the recommended blood pressure goals that will further reduce the high rates of illness and death attributable to diabetes and hypertension in the United States."

In addition to drug therapy, the NKF also recommends that patients with diabetes and hypertension get regular exercise, cease smoking and eat a balanced, healthy diet.

For more information about diabetes, hypertension and kidney disease, please contact the NKF at (800) 622-9010.

The National Kidney Foundation, Inc., a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation.

This initiative was supported, in part, by an unrestricted educational grant from Novartis Pharmaceuticals Corporation.