Certain diabetics more likely to benefit from blood pressure meds

People with type 2 diabetes who get treatment for high blood pressure live longer and have a lower risk of heart disease, according to a new review.

But to the researchers’ surprise, diabetics with only slightly high blood pressure - higher than the healthy range but not quite in the hypertension range - didn’t get as much benefit from treatment.

“Everything else being equal,” the patients with type 2 diabetes most likely to benefit from blood pressure lowering are those whose blood pressure is higher, said coauthor Professor Kazem Rahimi of The George Institute United Kingdom and The University of Oxford, in email to Reuters Health.

The review included 40 trials from 1966 to 2014 on blood pressure lowering treatments in more than 100,000 people with type 2 diabetes. The treatments included diuretics (sometimes called “water pills”), ACE inhibitors, and other drugs.

A healthy blood pressure reading is 120/80 millimeters (mm) of Mercury (Hg).

Readings above 120/80 but below 140/90 indicate “pre-hypertension.” Blood pressure above 140/90 mm Hg can be diagnosed as hypertension.

According to the new review, with every decrease of 10 mm Hg in the first number – the systolic blood pressure - the risk of dying during the study decreased by about 10 percent, and the risk of an acute heart problem, heart disease, stroke and diabetic retinopathy also went down.

Lowering blood pressure appeared to carry the most benefit for people whose initial systolic readings were higher than 140 mm Hg, the authors write in JAMA.

“The study calls for more individualized treatment decisions when it comes to controlling blood pressure in people with type 2 diabetes, in particular for diabetics with lower baseline blood pressure levels,” Rahimi said.

Blood pressure medications did decrease the risk of other problems like stroke, diabetic eye disease and excess protein in the urine, even for people with relatively lower blood pressures, he said.

But diuretics can cause an increase in blood sugar for people with diabetes. Other side effects of blood pressure medications include impotence, potassium deficiency, skin rash or kidney damage.

One in 10 Americans has diabetes today, most often type 2, the adult-onset kind, according to the Centers for Disease Control and Prevention. Two out of three people with diabetes have high blood pressure or take medication to lower it, according to the American Diabetes Association.

“People with a blood pressure of 140 or higher are likely to enjoy the greatest benefit from blood pressure lowering, and for most, the benefits of taking blood pressure medication are likely to outweigh the potential side effects,” Rahimi said. “In people with systolic blood pressure below 140 mm Hg, treatment recommendation requires more careful assessment of the patient’s likely absolute net benefit.”

Based on one U.S. trial in 2010, blood pressure goals have been relaxed for people with diabetes, which may have been an overreaction, according to Dr. Bryan Williams of University College London, who wrote an accompanying editorial in the journal.

Before that trial, most guidelines recommended that people with diabetes keep their blood pressure below 130/80 mm Hg. Afterward, some guidelines were relaxed to 140/90 mm Hg.

Rahimi’s study “shows that the current BP goals are not low enough to optimally reduce the risk of stroke, for example,” Williams told Reuters Health by email.

“Certainly BP should be lowered to below 140/90 mm Hg and I would suggest it would be appropriate to go lower than 130/80 if the patient will tolerate it and this is more likely to be tolerated better in younger people,” he said.

“There is no magical threshold above which blood pressure suddenly becomes harmful and below which it becomes benign,” Williams said. “The thresholds are designed to simplify trials and guidance but in reality the risk relationship is continuous with no obvious threshold.” — Reuters

Flaxseed may reduce blood pressure, early findings show

NEW YORK - Eating a bit of flaxseed each day might help lower high blood pressure, a new study suggests.

Researchers said it's too early to swap out blood pressure medication for the fiber-filled seeds just yet. But if future studies confirm the new results, flax might be a cheap way to treat high blood pressure, they added.

Flaxseed is well known as a plant source of omega-3 fatty acids, fiber and lignans, a type of antioxidants.

But so far, its effect on high blood pressure, or hypertension, has been better studied among animals than humans.

"This is the first demonstration of the cardiovascular effects of dietary flaxseed in a hypertensive population," Grant Pierce told Reuters Health in an email. Pierce is the senior author on the study and executive director of research at St. Boniface Hospital in Winnipeg, Manitoba, Canada.

One in three American adults has high blood pressure, considered 140/90 millimeters of mercury (mm Hg) and over, according to the National Institutes of Health.

Having high blood pressure increases a person's risk of heart disease and stroke. The condition costs the US billions of dollars each year, Pierce said.

"It is the number one reason for a person to visit a physician in the U.S. today," he said. "Understanding how to reduce blood pressure has become, therefore, a critical challenge."

His team's results were published in the journal Hypertension.

The trial included 110 people who had been diagnosed with peripheral artery disease, in which plaque builds up in arteries in the leg. Patients with the condition often have high blood pressure.

The participants were randomly assigned to either a flaxseed or comparison group.

People in the flaxseed group ate a variety of foods like bagels, muffins and pasta that contained 30 grams—about one ounce—of milled flaxseed every day for six months.

Those in the comparison group were given foods that tasted similar, but didn't contain any flaxseed.

The researchers had participants increase their dose of flaxseed gradually so they could become accustomed to the fiber load.

Still, one in five participants dropped out of each group during the trial. Some of that could have been due to stomach pain from the extra fiber, Pierce said.

People who had an initial systolic blood pressure—the top number in a blood pressure reading - of at least 140 mm Hg saw that figure drop by 15 mm Hg, on average, after six months of taking flaxseed.

Their diastolic blood pressure—the bottom number—also fell by 7 mm Hg. Blood pressure did not change among people with hypertension in the comparison group.

"These decreases in (blood pressure) are amongst the most potent dietary interventions observed and comparable to current medications," Pierce said.

There was no flaxseed-related benefit for people with normal blood pressure, however.

Flaxseed costs about 25 to 50 cents per ounce.

The new study was partially funded by the Flax Council of Canada. It wasn't originally designed to study blood pressure, which means the results have to be interpreted with more caution.

"The study results are indeed surprising—it is actually hard to imagine such huge reductions in blood pressure with flax seed mixed in food stuffs," Dr. William B. White told Reuters Health in an email.

White, from the University of Connecticut School of Medicine in Farmington, is also the president of the American Society of Hypertension. He was not involved in the new study.

He also expressed some concern that measuring blood pressure changes was not the initial reason for doing the study. And he said the way blood pressure was measured - during a single office visit - isn't as accurate as checking it at multiple points throughout the day.

"The results are preliminary—there is not enough information to justify people taking flax seed for the control of hypertension. A larger, more controlled trial with out-of-office blood pressure would be needed," White said.

According to Pierce, a new study is underway. — Reuters

source: gmanetwork.com