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Zhong
Li
SPLITTHE 'DEVIL'S
COMBINATION":
EXPLORING
A
REASONABLE
STRATEGY
FOR MANAGING DIABETES
AND
HYPERTENSION
Even before diabetes (type ll)
manifests itself,
a
pre-existing resis-
tance to insulin requires a higher blood
level of
insulin
to maintain normal blood
sugar level. Unfortunately, excessive
insulin causes retention
of
sodium and,
indirectly, hypertension. The 3rd Report
ol the
Adult
Treatment Panel
(ATP)
of
the
US National
Cholesterol
Educa-
tional Program
reported
that
for
those
diabetics who were without coronaries,
the
risk
was
raised to
that ol coronary
patients;
if
combined with hypertension,
the
risks were
4
times higher (compared
with
those without diabetes
nor
hypertension). According to the 12-yeat
lollow
up data
of
the
Multiple Risk Fac-
tor
lntervention Trial (MRFIT),
the
rela-
tive
risk of
death
of patients with com-
bined diabetes and hypertension dying
from cardio-vascular diseases was 2-4
times
higher than those
with
hyperten-
sion alone.
The
UK prospective
diabe-
tes study (UKPDS) showed that, with a
strict blood pressure control, after 8.4
years
of
follow
up,
there was
a
substan-
tial
reduction of
the
risk
of
retinal
complications, stroke and deaths
re-
lated to diabetes. As
for
the detail com-
parison of different categories of drugs
for
hypertension, physicians have, at
hand, data of
lrials
like
lhe
Appropriate
Blood Pressure Control
in
Diabetes
(ABCD),
the
Fosinipril
versus
Amlodipine Cardiovascular Random-
ized
Events Trial (FACET) and the
GISSI-3
(an ltalian
group) data
lor
reference.
Consult
your doctor for the
best advice.
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