“A review of the clinical trials shows there’s no question that the people who had better BP control did better in terms of reduced numbers of cardiovascular events,” Dr. Bakris observes. That outcome “has nothing to do with which drug was given; it has to do with whose BP control was better. It’s critical to understand that these are proven therapies that do work.”

Lifelong therapies

But attaining a BP goal is not enough—control must be sustained, Dr. Bakris emphasizes. For example, the original United Kingdom Prospective Diabetes Study defined aggressive BP control as a mean systolic BP of 144 mm Hg. Diabetic patients who hit that mark had far fewer cardiovascular events than those who followed the conventional treatment (resulting in an average systolic BP about 10 mm Hg higher). Now, a new 10-year follow-up2 reports “no appreciable difference [in cardiovascular events] because subjects had allowed their BP to creep up,” says Dr. Bakris.

“The benefits of previously improved BP were lost when good BP control was not maintained,” Dr. Bakris comments. “The critical message is that early improvement in BP control in patients with type 2 diabetes and hypertension is associated with reduced risk of complications, but [this reduction] appears to last only as [long] as the BP continues to be controlled.


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“This is about morbidity, not mortality,” he adds. “We need to understand that these therapies are not transient; they’re lifelong therapies. I think that’s a very big deal.”

Both hypertension and diabetes have risen sharply in the past decade, trends that show no signs of abating. Hypertension affects 70 million Americans. New data from the National Health and Nutrition Examination Surveys show the prevalence has increased from almost 25% during 1988-1994 to 28.9% during 1999-2004.3

Meanwhile, the CDC estimates that 23.6 million American adults and children now have diabetes, with type 2 accounting for 90%-95% of those cases. The rate of new diagnoses has almost doubled from 4.8 per 1,000 people in 1995-1997 to 9.1 per 1,000 between 2005 and 2007.4

It’s no coincidence that those increases mirror the steady rise in obesity and that hypertension, diabetes, and overweightare trickling down to children and adolescents.