ANTIHYPERTENSIVE TREATMENT AND MORTALITY IN DIABETIC-PATIENTS - WHAT IS THE EVIDENCE

In follow-up studies patients with hypertension and non-insulin-depend ent diabetes mellitus (NIDDM) have a four to sevenfold increase in tot al mortality when compared to non-diabetic normotensive subjects. Rece ntly, the risk of mortality associated with hypertension in diabetes w as assessed in 3648 newly diagnosed NIDDM patients [1], hypertension w as present in 35 % of women and 46 % of men. When compared to normoten sive diabetic patients the mortality risk associated with hypertension was doubled over a median follow-up period of 4.6 years. Cardiac even ts including sudden death accounted for 58 % and stroke for 13 % of al l causes of death. Patients with insulin-dependent diabetes mellitus ( IDDM) exhibit a dramatically reduced life expectancy when they develop diabetic nephropathy which is nearly always associated with hypertens ion [2], Without antihypertensive treatment the 10-year mortality appr oaches 80 % in these patients and the main causes of death are myocard ial infarction, cardiac failure, sudden death and stroke [3, 4]. Hence , there is no doubt that hypertension adds considerably to the already increased morbidity and mortality risk in NIDDM patients and is the m ajor determinant of the prognosis in nephropathic IDDM patients.