New Diabetes Patients and Blood Pressure

Newly diagnosed diabetes and hypertension patients may have more time to learn how to control their high blood pressure without medications.
The consequences of delaying effective hypertension treatment for up to a year were small—only a two day reduction in quality-adjusted life expectancy—according to a study by University of Chicago researchers.
"Most patients would prefer to control their blood pressure through diet and exercise rather than with medications, and it can take months to learn how to change old habits and master new skills. Our results indicate that it's OK to spend from six months to a year, perhaps even longer, to make the difficult lifestyle changes that are necessary and will pay off in the long run." For newly diagnosed patients, this means we have time," study author Neda Laiteerapong, MD, instructor of medicine at the University of Chicago, was quoted as saying.
High blood pressure is particularly damaging for people with diabetes, increasing their risk of kidney failure, stroke, vision loss and amputations. The American Diabetes Association and the National Institute of Health both recommend a lower blood pressure goal for patients with diabetes then for the general public. They urge them to keep their blood pressures below 130/80 mmHg.

Unfortunately, two out of three adults with diabetes never accomplish that goal. Many patients are hindered by limited health care. While others are delayed by the hesitance of patients to implement lifestyle changes or reluctance by their doctors to push additional medications.
Until recently, the implications of these delays on patients' health had not been determined. Laiteerapong and colleagues determined the magnitude of harm caused by different delays in controlling blood pressure in patients from 50-59 years of age with newly diagnosed type 2 diabetes. With the use of computer models and published data, they found the damage caused by a one-year delay may be small but delays of ten years or more were comparable to smoking in patients with cardiovascular disease.
Many patients would prefer to control blood pressure through diet and exercise rather than with antihypertensive medications if given time to learn how to do so. Most guidelines, however, recommend at most a three-month trial of medication-free lifestyle therapy for patients with moderately elevated blood pressure.

Unfortunately that is often not enough time for patients to learn the methods, develop good habits, and demonstrate improvements.
"We ask patients with diabetes to do a billion things," Laiteerapong was quoted as saying, "to test their blood sugars, to count carbohydrates, to spend 30 minutes a day doing exercise. Most, if not all, of this is new to them. They need time to adapt. It's important to do this right, but our results say it's not that important to do it so fast."
This study argues that caregivers assist patients to help them develop the necessary skills gradually as opposed to rushing to medications, especially if their blood pressure is only mildly elevated. The authors suggest that patients and providers "have more time, at least up to one year, to focus on diabetes self-management and lifestyle modification."
Authors were quoted as saying "Health care providers may wish to focus on diabetes management alone in the first year after diagnosis, to help patients establish effective self-management and lifestyle modification. However, after the first year, it is clear that achieving and maintaining tight blood pressure control among US middle-aged adults with diabetes has the potential to generate substantial population-level health benefits."
SOURCE: Journal of General Internal Medicine, January 9, 2012
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