Middle-aged people diagnosed with diabetes and hypertension have time to learn how to control blood pressure without drugs, but not too much time, shows study.

"For newly diagnosed patients, this means we have time," said study author Neda Laiteerapong, MD, instructor of medicine at the University of Chicago. "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."
High blood pressure is especially damaging for people with diabetes, raising their risk of stroke, coronary artery disease, kidney failure, vision loss and amputations. Both the American Diabetes Association (ADA) and the National Institutes of Health recommend a lower blood pressure target for patients with diabetes than for the general public, urging them to keep their pressures below 130/80 mmHg.
Two out of three adults with diabetes, however, never reach that goal. Many patients are hampered by limited access to health care. Others are delayed by what the authors call "clinical inertia," a disinclination by patients to implement lifestyle changes or reluctance by their doctors to push additional medications. Among those who are prescribed blood pressure drugs, at least 20 percent of patients with diabetes do not stick to their treatments.
Until now, the implications of these delays on patients' health had not been quantified. Laiteerapong and colleagues built computer models using published data to determine 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. The damage caused by a one-year delay "may be small," they concluded but delays of ten years or more were comparable to smoking in patients with cardiovascular disease.
Given time to learn how, many patients would prefer to control blood pressure through diet and exercise rather than with antihypertensive medications. Most guidelines, however, including those of the ADA, recommend at most a three-month trial of medication-free lifestyle therapy for patients with moderately elevated blood pressure. They call for immediate initiation of medication for those with blood pressure more than 10mmHg above the goal.
Advertisement
"We ask patients with diabetes to do a billion things," Laiteerapong said, "to test their blood sugars, to count carbohydrates, to spend 30 minutes a day doing exercise, including cardio and weight training. 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."
Advertisement
"Among middle-aged adults with diabetes, the harms of a one-year delay in managing blood pressure may be small," the authors conclude. "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-Eurekalert