Hypertension artérielle et diabète

Hypertension artérielle et diabète
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Plan I.- Qu’est-ce que la pression artérielle ? a) ne pas confondre avec la tension nerveuse b) Pression artérielle systolique et diastolique c) Définition de l’hypertension artérielle II.- Fréquence de l’hypertension artérielle III.- L’hypertension artérielle: -maladie ? -Facteur de risque cardio-vasculaire? IV.- Causes: a) Hypertension artérielle primaire b) Hypertension artérielle secondaire V.- Hypertension et diabète: un mauvais couple! VI.- Quelques éléments de traitement a) non médicamenteux b) médicamenteux

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Qu’est-ce que la pression artérielle ? Le cœur à chaque contraction éjecte de 70 à 100 ml de sang dans les vaisseaux sanguins. Ainsi, à chaque contraction, on obtient un pic de pression dans le lit vasculaire qui va lentement se vider jusqu’à la contraction suivante. La pression dans les vaisseaux : au moment du pic est appelée pression artérielle systolique au moment où elle est la plus basse: pression artérielle diastolique

Perico N, Remuzzi A, Sangalli F, et al
Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9: Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102: Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36: Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39: Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36: Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118: Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31: Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37: Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27: Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9: Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25: Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5: Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13: Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82: Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350: Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16: Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42: Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17: Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102: Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340:

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Qu’est-ce que l’hypertension artérielle ?

Risque absolu = risque de base x R. relatif 1 x R. relatif 2 x …
90 80 70 60 50 40 30 20 10 RR=1.4 ER=24 RR=2.0 ER=33 Taux de mortalité à 6 ans en o/oo RR=1.3 ER=20 RR=1.4 ER=8 Risque de base PAD > 90 mmHg Cholestérol > 6.4 mmol/l Fumeurs D'après la Multiple Risk Factor Intervention Trial

Bénéfice à traiter en fonction du niveau de la pression artérielle
Taux de complications cardio- vasculaires A Traitement bénéfique A = baisse de la pression artérielle = effets secondaires du traitement A Traitement néfaste Pression artérielle

Perico N, Remuzzi A, Sangalli F, et al. The antiproteinuric effect of angiotensin antagonism in human IgA nephropathy is potentiated by indomethacin. J Am Soc Nephrol 1998;9: Pinel N, Fadel B, Bilous RW, et al. Renal biopsies in 30 micro and macroalbuminuric type 2 patients. Heterogeneity of renal lesions. Diabetologia 1995;38(suppl 1):A217. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000;102: Pohl M, Cooper M, Ulrey J, et al. Safety and efficacy of irbesartan in hypertensive patients with type II diabetes and proteinuria. Am J Hypertens 1997;10:105A. Abstract. Pugh JA, Medina R, Ramirez, M. Comparison of the course to end-stage renal disease of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic nephropathy. Diabetologia 1993;36: Raine AEG, Bilous RW. End-stage renal disease in NIDDM: a consequence of microangiopathy alone? Diabetologia 1996;39: Raine AEG. Epidemiology, development and treatment of of end-stage renal failure in type 2 (non-insulin dependent) diabetic patients in Europe. Diabetologia 1993;36: Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118: Reeves RA, Lin C-S, Kassler-Taub K, Pouleur H. Dose-related efficacy of irbesartan for hypertension: an integrated analysis. Hypertension 1998;31: Ribstein J, Picard A, Armagnac C, et al. Inhibition of the acute effects of angiotensin II by the receptor antagonist irbesartan in normotensive men. J Cardiovasc Pharmacol 2001;37: Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kid Dis 1996;27: Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progresion in diabetic nephropathy. Kidney Int 1994;45(suppl.):S145-S149. Ruggenenti P, Gambara V, Perna A, et al. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol 1998;9: Savage S, Niegel NJ, Estacio RO, et al. Clinical factors associated with urinary albumin excretion in type II diabetes. Am J Kid Dis 1995;25: Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med 1988;5: Schwartz MM, Lewis EJ, Leonard-Martin T, et al. Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transpl 1998;13: Simon TA, Gelarden T, Freitag SA, et al. Safety of irbesartan in the treatment of mild to moderate systemic hypertension. Am J Cardiol 1998;82: Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350: Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in multiple risk factor intervention trial. Diabetes Care 1993;16: Stone PH, Muller JE, Hartwell T, et al. The effect of diabetes mellitus on pronosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Cardiol 1989;14:49-57. Suzuki Y, Ueno M, Hayashi H, et al. A light microscopic study of glomerulosclerosis in Japanese patients with non-insulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 1994;42: Tarnow L, Rossing P, Gall M-A, et al. Prevalence of arterial hypertension in diabetic patients before and after the JNC-V. Diabet Care 1994;17: Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin -converting enzyme inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 2000;102: Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340: Hommes 55 ans High risk = fumeur, intolérance au glucose, hypercholestérolémie >8 mmol/l HVG Alderman MH. Blood pressure management: individualized treatment based on absolute risk and the potential for benefit. Ann Intern Med 1993; 119:

Directives ESH-ESC 2007 Pression artérielle (mmHg)
Normal /80-84 Normal sup. /85-89 HTA stade 1 /90-99 HTA stade 2 / HTA stade 3 >180/>110 Pas d’autre FRCV Risque négligeable Risque faible Risque modéré Risque très élevé 1-2 FRCV 3 FRCV; synd. métabolique ou lésions infraclin. organes cibles Risque élevé Diabète MC ou néphropathie symptomat

Atteinte des organes cibles Conditions cliniques associées
ESC/ESH 2007 Facteurs de risque Atteinte des organes cibles Conditions cliniques associées Hommes plus de 55 ans Femmes plus de 65 ans Tabagisme Cholestérol > 5.0 mmol/l mmol/l. Diabète Ant. familiaux de mal. CV Pris en compte dans la stratifications: HDL chol.< 1 mmol/l LDL chol. >3 Microalbuminurie dans le diabète Intolérance au glucose Obésité abdominale(102/88) TG 1.7 mmol/l HVG (ECG,Echocar.,Rx thorax) Protéinurie ou augmentation de la créatinine ( mmol/l.) Microalbuminurie Filtration glomérulaire:<60 ml/min/1.73 m2 Plaque artérioscléreuse Rétrécissement généralisé ou focal des art. rétiniennes AVC (toutes formes) Infarctus myocardique Angine de poitrine Revascularisation coronaire Insuffisance cardiaque Néphropathie diabétique Insuffisance rénale (> 177 mmol/l. ) Anévrisme disséquant Mal. Artérielle symptomatique Rétinopathie hypertensive avancée (œdème papillaire,hémorragie ou exsudat) . Dr B. Jacot Des Combes, oct 2007

Définition de l’hypertension artérielle en cas de diabète
Take home message: La pression artérielle idéale pour un diabétique est que la moyenne des mesures de la pression artérielle soit plus petite ou égale à 125 / 85 mmHg soit 12,5/8,5 cmHg

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77:

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Globalement: 5% des enfants : principalement hypertensions artérielles secondaires 15% des adultes entre 20 et 65 ans 50 % des adultes âgés de plus de 65 ans

Prevalence of Hypertension in Type 2 Diabetes
Normoalbuminuria (UAE  30 mg/day) Microalbuminuria (UAE mg/day) Macroalbuminuria (UAE  300 mg/day) All patients 100 93 90 80 71 Prevalence of hypertension (%) 50 Hypertension is very common among patients with diabetes, especially diabetic patients with evidence of renal disease. Hypertension is very common among patients with diabetes, with a prevalence approximately twice that of the nondiabetic population, and may precede the onset of diabetes.1,2 The prevalence of hypertension is further increased in patients with type 2 diabetes and renal disease, as manifested by elevated urinary albumin excretion rates, compared with patients with type 2 diabetes and no evidence of renal involvement. A study including a cohort of 549 patients with type 2 diabetes (mean age 60 years) identified a high prevalence of hypertension, on the basis of an average blood pressure (BP)  140/90 mm Hg during a 3-year follow-up period.3 Eighty percent of the patients were classified as hypertensive, ranging from 71% of patients with normal urinary albumin excretion (UAE  30 mg/day) to 93% in patients with macroalbuminuria (UAE  300 mg/day). Only 41% of the patients were receiving antihypertensive treatment. Even in treated patients, 92% of those with normoalbuminuria, 92% of those with microalbuminuria (UAE mg/day), and 88% of those with macroalbuminuria were uncontrolled, with a BP  140/90 mm Hg. Average BP was 163/90, 165/88, and 161/92 mm Hg in the 3 groups, respectively, despite antihypertensive therapy. 1 Epstein and Sowers, 1992. 2 American Diabetes Association, 2001. 3 Tarnow et al, 1994. n=323 n=151 n=75 n=549 Hypertension defined as ³140/90 mm Hg. UAE = urinary albumin excretion Tarnow L et al. Diabetes Care 1994;17:

Prevalence of Hypertension in Type 1 Diabetes
Rare au moment du diagnostic, mais elle se développe dans les 10 à 12 ans suivant le diagnostic pour atteindre une prévalence aussi élevée que dans le diabète de type II Hypertension is very common among patients with diabetes, especially diabetic patients with evidence of renal disease. Hypertension is very common among patients with diabetes, with a prevalence approximately twice that of the nondiabetic population, and may precede the onset of diabetes.1,2 The prevalence of hypertension is further increased in patients with type 2 diabetes and renal disease, as manifested by elevated urinary albumin excretion rates, compared with patients with type 2 diabetes and no evidence of renal involvement. A study including a cohort of 549 patients with type 2 diabetes (mean age 60 years) identified a high prevalence of hypertension, on the basis of an average blood pressure (BP)  140/90 mm Hg during a 3-year follow-up period.3 Eighty percent of the patients were classified as hypertensive, ranging from 71% of patients with normal urinary albumin excretion (UAE  30 mg/day) to 93% in patients with macroalbuminuria (UAE  300 mg/day). Only 41% of the patients were receiving antihypertensive treatment. Even in treated patients, 92% of those with normoalbuminuria, 92% of those with microalbuminuria (UAE mg/day), and 88% of those with macroalbuminuria were uncontrolled, with a BP  140/90 mm Hg. Average BP was 163/90, 165/88, and 161/92 mm Hg in the 3 groups, respectively, despite antihypertensive therapy. 1 Epstein and Sowers, 1992. 2 American Diabetes Association, 2001. 3 Tarnow et al, 1994.

Take home message: L’hypertension artérielle, est asymptomatique et
Hypertension artérielle et diabète UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Take home message: L’hypertension artérielle, est asymptomatique et est une « tueuse silencieuse » Semblable aux termites, elle ronge le bâtiment, pratiquement sans signe jusqu’à ce qu’il s’écroule.

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Environ le 95 % de toutes les hypertension artérielles sont dues à des prédispositions génétiques qui vont se révéler si : - excès de sel (NaCl) - excès de poids - manque d’activité physique Environ 5% sont dues à des affections telles que: - insuffisance rénale - obstruction des artères rénales - diverses maladies endocriniennes

Association of Systolic BP and Cardiovascular Death in Type 2 Diabetes
Hypertension artérielle et diabète Association of Systolic BP and Cardiovascular Death in Type 2 Diabetes UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: 250 Nondiabetic Diabetic 225 200 Cardiovascular mortality rate/10,000 person-yr 175 150 125 100 75 50 25 < 120 120–139 140–159 160–179 180–199 ³ 200 Systolic blood pressure (mm Hg) Stamler J et al. Diabetes Care 1993;16:

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Dicton populaire: On a l’âge de ses artères

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Les traitements antihypertenseurs ralentissent le vieillissement artérielle et sont ainsi une véritable fontaine de jouvence

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Des faits: Entre 2 et 3 g. de sel suffisent par jour En Suisse la consommation de sel moyenne est de 12 g. En diminuant à 6 g. par jour on pourrait éviter en Suisse 1’700 attaques cérébrales 2’575 infarctus myocardiques

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Relative risk reduction for incident hypertension associated with sustained weight loss of 1.8 kg: The Framingham Study Cohort Risk reduction (%) Relative risk 95% CI Age 30–49 22 0.78 0.60–1.03 Age 50–65 26 0.74 0.56–0.97 Moore LL et al. Arch Intern Med 2005; 165:

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Relative risk reduction for incident hypertension associated with weight loss of 6.8 kg: The Framingham Study Cohort Risk reduction (%) Relative risk 95% CI Age 30–49 28 0.72 0.49–1.05 Age 50–65 47 0.63 0.42–0.95 Moore LL et al. Arch Intern Med 2005; 165:

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: A bon entendeur SALUT !

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Courbe de survie pour personnes de 50 ans selon le degré d’activité physique Soit environ 10 % de plus de survivant à 75 ans

390 dans groupe moins contrôlé (<180/105) Follow-up moyen : 8.4 ans
Hypertension artérielle et diabète UKPDS - Sujets et méthode UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: 1148 patients Age moyen 56 ans PA moyenne 160/94 mmHg 758 randomisés dans groupe de contrôle stricte de la PA(<150/85 mmHg) 390 dans groupe moins contrôlé (<180/105) Follow-up moyen : 8.4 ans

Groupe A = contrôle stricte < 150/85
Hypertension artérielle et diabète UKPDS-Principaux résultats (1) UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Groupe A = contrôle stricte < 150/85 Groupe B = contrôle - stricte < 180/ %<150/85 Gr. A:PA moyenne 144/ %<180/ %<150/85 Gr. B: PA moyenne 154/ %<180/105

de 34 % des atteintes macrovasulaires*.
Hypertension artérielle et diabète UKPDS-Principaux résultats (2) UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: de 44 % des AVC de 34 % des atteintes macrovasulaires*. de 37 % des atteintes microvasculaires** *:AVC+Infarctus+morts subites+amputations **:rétinopathie, albuminurie

Entre les Gr A et Gr B il existe une de :
Hypertension artérielle et diabète UKPDS-Principaux résultats (3) UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Entre les Gr A et Gr B il existe une de : 56 % des insuffisances cardiaques 35% des photocoagulations rétiniennes

je vous remercie de votre attention
Hypertension artérielle et diabète UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998a;317: UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998b;317: UK Prospective Diabetes Study Group. Study design, progress and performance. Diabetologia 1991;34: United States Renal Data System, USRDS 1999 Annual Data Report. National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, April, 1999. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), National Center For Health Statistics. (Vital and health statistics, plan and operation of the third national health and nutrition and examination survey, ). DHHS publication no. (PHS) , series 1, No Valentino VA, Wilson MD, Weart W, Bakris GL. A perspective on converting enzyme inhibitors and calcium channel antagonists in diabetic renal disease. Arch Intern Med 1991;151: Velussi M, Brocco E, Frigato F, et al. Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes 1996;45: Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II? Clin Neph 1992;37: Wang S-L, Head J, Stevens L, et al. Excess mortality and its relation to hypertension and proteinuria in diabetic patients. Diabetes Care 1996;19: Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: An updated meta-analysis. Nephrol Dial Transplant 1995;10 (suppl 9):39-45. World Health Organization. The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva, Switzerland Zanchetti A, Agabiti-Rosei E, Dal Palu C, et al. The verapamil in hypertension and atherosclerosis study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 1998;16: Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomuerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986;77: Enfin C'est la fin je vous remercie de votre attention

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