Till date there are no studies existing that have established as to whether a very aggressive antihypertensive treatment is effective in protecting from target organ damage in hypertensive diabetes patients. To throw more light onto this issue, Dr. Eguchi Kazuo and coworkers performed the present study that tested the hypothesis that a very aggressive antihypertensive treatment is beneficial for target organ protection in patients with type 2 diabetes/pre-diabetes.
Study population consisted of 60 subjects with hypertension and diabetes/pre-diabetes but with home BP > 135/85 mmHg.
As a part of study protocol, researchers used irbesartan, amlodipine, and indapamide according to a titration schedule from step 1 to step 5. The target home BP level was set as <125/75 mmHg.
Moreover, the flow-mediated vasodilation (FMD), radial augmentation index (AI), pulse wave velocity (PWV) and urinary albumin excretion ratio (UACR) were used as surrogates for successful antihypertensive treatment in addition to clinic, home, and ambulatory BP.
Findings from this study showed significantly lower clinic SBP, home morning SBP and 24-hr SBP in the 6th month (table 1, all p < 0.001) when compared with the baseline values
Table 1: Lowered blood pressure parameters at 6th months
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Clinic SBP
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Home morning SBP
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24-hrs SBP
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Baseline values
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147 ± 18 mmHg
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145 ± 17 mmHg
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138 ± 13 mmHg
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At 6th month
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125 ± 15 mmHg
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128 ± 11 mmHg
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125 ± 11 mmHg
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Significantly increased FMD was reported (table 2, p < 0.001) and significantly reduced AI, pulse wave velocity, and urinary albumin excretion ratio were also reported by the treatment.
Table 2: Flow-Mediated Vasodilation
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FMD
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Baseline values
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5.3 ± 2.1 %
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At 6th month
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5.9 ± 1.6 %
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Additionally, association was shown by the extent of pulse wave velocity and urinary albumin excretion ratio changes with the changes in all BP measures, but only the change in home morning BP was associated with the change in FMD (figure). Furthermore, there was no association found between the changes in radial augmentation index and the changes in BP levels but changes in radial augmentation index were associated with the pulse wave velocity changes.
Figure: Association of Flow-Mediated Vasodilation only with morning Home BP change
Based on all the above findings this study concluded that an ARB-based aggressive antihypertensive therapy guided by home BP monitoring in patients with diabetes/pre-diabetes was effective in improving cardiovascular target damage. | 
