Study Indicates Aggressive Treatment Helps African Americans With Diabetes, High Blood Pressure
Data presented at ISHIB 2004, the annual congress of the International Society on Hypertension in Blacks, indicate that African American patients with type 2 diabetes and high blood pressure benefit from aggressive use of combination high blood pressure therapy. The study, “Lotrel and Enalpril in African Americans with Diabetes (LEAAD),” demonstrates that providing patients with a combination of two highly effective medications in one capsule helps them reach the rigorous blood pressure goal of less than 130/80 mm Hg (the measurement scale for high blood pressure).
High blood pressure is extremely common in the African American community; nearly one in three Blacks has the condition. In addition, diabetes is more prevalent in African Americans than in the general population; Blacks are 1.6 times more likely to have diabetes than non-Hispanic Whites of similar age. When high blood pressure and diabetes occur together, the risk of heart disease and kidney disease greatly increases. Because of the dangers of uncontrolled high blood pressure in those with diabetes, national guidelines released last year by ISHIB recommend these patients be treated to a blood pressure goal of less than 130/80 mm Hg. ISHIB also recommends that many of these patients, especially those with blood pressures greater than 15/10 mm Hg above their goal, receive two or more medications when they are first diagnosed.
“All patients, especially African Americans, should understand that diabetes and high blood pressure is a dangerous combination, which, if left uncontrolled, significantly increases the risk of life-threatening complications,” said Dr. John Flack, lead investigator of the study, ISHIB president, and associate chairman and quality officer at the department of medicine at Wayne State University School of Medicine. “I urge all African Americans with both high blood pressure and diabetes to talk to their physicians about combination therapy, which this study demonstrates helps patients achieve blood pressure goals quickly and effectively.”
LEAAD evaluated the effectiveness and safety of the combination of amlodipine, a calcium channel blocker, and benazepril, an ACE inhibitor in a single-capsule versus enalapril, a commonly prescribed ACE inhibitor. The 269 African American patients with type 2 diabetes participating in the trial were provided with the combination of amlodipine/benazepril or enalapril at the beginning of the 24-week study. In LEAAD, the majority of patients taking amlodipine/benazepril reached the blood pressure goal of less than 130/80 mm Hg. Sixty percent of patients treated with amlodipine/benazepril reached this target versus only 44 percent of those taking enalapril.
LEAAD was primarily designed to test the amount of time it took patients in the study to reach the blood pressure goal of less than 130/80 mm Hg. Those on amlodipine/benazepril reached the target blood pressure in about 10.1 weeks versus 10.5 weeks for those on enalapril.
“These data show that patients can reach aggressive blood pressure goals quickly using combination therapy,” Flack said. “As a clinician, however, my most important objective is to get patients to their blood pressure target and this study demonstrates that aggressive use of combination therapy can help significantly more patients get to goal than single therapy alone.”
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