ANTIHYPERTENSIVE THERAPY IN TYPE-2 DIABETES - IMPLICATIONS OF THE APPROPRIATE BLOOD-PRESSURE CONTROL IN DIABETES (ABCD) TRIAL

As the population ages, the incidence of type 2 diabetes will increase as will the incidence of concomitant vascular complications. Hyperten sion substantially increases the risk of cardiovascular disease in pat ients with diabetes. Results from the recent Appropriate Blood Pressur e Control in Diabetes (ABCD) trial demonstrated an advantage of an ang iotensin-converting enzyme (ACE) inhibitor (enalapril) over a long-act ing calcium antagonist (nisoldipine) with regard to the incidence of c ardiovascular events over a 5-year follow-vp period in hypertensive pe rsons with type 2 diabetes. This trial was a prospective, randomized, blinded study comparing the effects of moderate blood pressure control (target diastolic pressure 80-89 mm Hg) with those of intensive contr ol (target diastolic pressure 75 mm Hg) on the incidence and progressi on of diabetic vascular complications, The study also compared nisoldi pine with enalapril as first-line antihypertensive therapy in terms of prevention and progression of complications of diabetes. In 470 hyper tensive patients, the incidence of fatal and nonfatal myocardial infar ctions was significantly (p = 0.001) higher among those receiving niso ldipine (n=25) compared with those receiving enalapril (n = 5), Compar ison with previous studies suggests that the difference observed betwe en nisoldipine and enalapril resulted from a beneficial effect of enal april rather than a deleterious effect from nisoldipine, Since these f indings in the ABCD trial are based on a secondary endpoint, they requ ire confirmation. Nevertheless, they suggest that ACE inhibitors shoul d be the initial antihypertensive medication used in patients with typ e 2 diabetes and hypertension. (C) 1998 by Excerpta Medica, Inc.