-- Mary Elizabeth Dallas
MONDAY, Jan. 9 (HealthDay News) -- Waiting up to a year to treat
high blood pressure in a person with diabetes is probably not
harmful, but waiting many years to get blood pressure under control
could result in serious complications, new research indicates.
In the study, published online Jan. 9 in the
Journal of General Internal Medicine, researchers from the University of Chicago suggested that the one-year delay could give patients time to make certain lifestyle changes that could help correct the problem, such as limiting their salt intake, exercising or losing weight.
The study also suggests that delays in lowering blood pressure
among patients with diabetes are not uncommon. Some patients may
not have access to health care, while others may not follow through
on their treatment, they explained.
Still, other experts were cautious, noting that prompt control
of blood pressure with medications can prevent serious
In the study, a team led by Dr. Neda Laiteerapong used a
simulated model with a theoretical population of adults in their
50s newly diagnosed with type 2 diabetes.
The researchers found that a lifetime of uncontrolled blood
pressure increased complications significantly, or by 1,855 events
per 10,000 patients. It also reduced their life expectancy by
almost one year.
In contrast, a one-year delay in controlling blood pressure
resulted in only a minor increase in the number of complications
and reduced life expectancy by only two days.
However, waiting very long before treatment wasn't advised. The
study authors found that 10 years or more of delays in the
treatment of high blood pressure could lead to serious health
problems, including greater risk for stroke and heart attack.
"Among middle-aged adults with diabetes, the harms of a one-year delay in managing blood pressure may be small. Health care providers may wish to focus on diabetes management alone in the first year after diagnosis, to help patients establish effective self-management and lifestyle modification," Laiteerapong and colleagues wrote in a journal news release.
Experts said the findings add to the debate on when to initiate
therapy, but questioned the authors' conclusions.
The study "contributes to the ongoing discussion about blood
pressure targets and the importance of blood pressure control in
people who have diabetes," said Dr. Ronald Tamler, clinical
director of the Mount Sinai Diabetes Center in New York City.
"However, we should not forget that this latest study is merely a computer simulation. Studies have shown that uncontrolled blood pressure in real patients with diabetes is still a source of concern and
may lead to complications, such as heart disease, stroke and kidney
disease," added Tamler, who is also assistant professor of medicine
at the center.
One cardiologist added that quick action in getting blood
pressure under control can be life-saving, and he questioned
whether waiting for lifestyle changes to occur was advisable.
Dr. Henry Black, clinical professor of cardiology at NYU Langone
Medical Center in New York City, said that many studies have shown
prompt control of blood pressure reduces events, although
neither of these studies were
specifically aimed at patients with diabetes, although many
of the study volunteers had diabetes mellitus."
According to Black, most trials have found changes in lifestyle
to be less effective than drug therapy in reining in high blood
pressure. That means that, "dithering with 'lifestyle changes' . .
. will delay getting effective treatment to these high-risk
individuals," he said. "The time wasted focusing on control of
diabetes with lifestyle changes is a bad bargain, if blood pressure
is pushed to the back burner."
The U.S. National Heart, Lung, and Blood Institute has more
lowering blood pressure.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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