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    Untreated High Blood Pressure and Cholesterol Common in Diabetes

    About three-quarters of American adults with diabetes have high blood pressure, and almost all have high cholesterol. Many people don't even know they have these conditions, according to researchers, and they aren't getting the treatment they need.

    At the scientific session of the American Diabetes Association in San Antonio this week, Linda Geiss and Deborah Rolka, both of the Division of Diabetes Translation at the Centers for Disease Control in Atlanta, Georgia, reported on data collected in the third National Health and Nutrition Examination Survey between 1988 and 1994. About 1,500 of the participants in this nationally representative survey had been diagnosed with diabetes.

    "We know that people with diabetes have a particularly high risk for cardiovascular disease, and a large part of this elevated risk is due to lipid abnormalities," noted Rolka. "We also know that people with diabetes can benefit from the available effective treatment that exists for dyslipidemia [abnormal levels of lipids].

    Lipids are the fats that most people think of as cholesterol: LDL, or low-density lipoproteins, HDL, or high-density lipoproteins, and triglycerides. Risk for cardiovascular disease is considered low if LDL is less than 100 mg/dl, HDL is more than 45 mg/dl for men or 55 mg/dl for women, and triglycerides are less than 200 mg/dl. Cardiovascular risk is considered high if LDL is more than 130 mg/dl, HDL is less than 35 mg/dl for men or 45 mg/dl for women, and triglycerides are more than 400 mg/dl.

    "What we found was that among all U.S. adults with reported diabetes, 97 percent, almost all, had at least one lipid abnormality," reported Rolka. "Fifty-six percent had LDL greater than 130 mg/dl, which is a particularly bad level of LDL, which is the "bad" cholesterol. Seventy-six percent were at high risk for cardiovascular disease, based on their lipid profile, and 21 percent were at borderline risk for cardiovascular disease."

    What's worse, said Rolka, is that many of these people with diabetes don't realize they're at risk. "Only 78 percent said that they had ever had their cholesterol checked, and only 36 percent said that they had ever been told that their cholesterol was high." About one-third of those surveyed said they'd ever done anything to reduce their cholesterol, including diet, weight loss, exercise, or taking prescription medication.

    "Only nine percent were taking prescribed medicine, and only nine percent were doing all of these things," noted Rolka. "Even among those who were following any treatment for high cholesterol, only one percent had LDL less than 100."

    Current recommendations are to start drug therapy for high cholesterol when LD is above 130 mg/dl, or when it's above 100 mg/dl in those with cardiovascular disease or multiple risk factors, Rolka explained. Yet among the survey participants, only 38 percent of those who should have been getting drug therapy were-leaving 62 percent untreated.

    "We know that lipid control is possible, that treatments exist that work. Clinical trials have shown this. So what we see is that there's large potential for increasing awareness, control, and treatment," concluded Rolka. She noted that since the survey was done, new awareness and new guidelines have been established. The current findings can thus be used as a baseline to look and see if any of these factors have improved.

    Geiss, who presented data from the same survey relating to high blood pressure, reported similar findings. Current recommendations are that among patients with diabetes, drug therapy should be started if systolic blood pressure (the "top" number) is 130 mm Hg or greater, or if diastolic pressure (the "bottom number) is 85 mm Hg or greater.

    Based on the survey findings, Geiss reported that 56.7 percent of American adults with diabetes have blood pressure greater than 140/90 mm Hg, and 71 percent have pressure greater than the treatment goal of 135/85 mm Hg.

    With increasing age, the survey found increasing prevalence of high blood pressure. In addition, women with diabetes were more likely to have high blood pressure than men, and blacks were more likely to have it than whites. Hispanics were the least likely of the three ethnic groups to have hypertension, but still 64 percent of Hispanic diabetics had pressure greater than 130/85 mm Hg.

    As with high cholesterol, many people weren't even aware that they had high blood pressure. Only 71 percent reported that they'd been told about their hypertension, and only 57 percent were taking medications to control it.

    Even among those taking medication, less than half had blood pressure less than 140/90 mm Hg, and only 12 percent had pressure less than 130/85 mm Hg, the currently recommended level.

    "Almost three-quarters of persons with diabetes are or should be treated for elevated blood pressure," concluded Geiss. "Control of blood pressure was poor, even among those receiving drug therapy."

    "Given this high prevalence of hypertension among diabetic patients, we need more effective interventions to prevent it. The detection and treatment of high blood pressure needs to be improved," she stated. "Much can be done to improve awareness, treatment, and control of hypertension among persons with diabetes.

    These findings about high cholesterol and high blood pressure are particularly important because in the past few years, clinical trials have shown that controlling cholesterol and blood pressure, as well as blood sugar, reduces the risk of cardiovascular complications among those with type 2 diabetes. The bottom line is that the more you can do to keep your blood sugar, blood pressure, and cholesterol at good levels, the less likely you are to develop heart disease and suffer heart attacks or stroke.


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