Association Trends Between Antihypertensive Drug Therapies and Diastolic Hypotension in Emirati Patients with Type 2 Diabetes: A Single-Center Retrospective Longitudinal Study

Bashair M Mussa; Rifat A Hamoudi; Salah E Abusnana

doi:10.1007/s13300-018-0469-2

Association Trends Between Antihypertensive Drug Therapies and Diastolic Hypotension in Emirati Patients with Type 2 Diabetes: A Single-Center Retrospective Longitudinal Study

Diabetes Ther. 2018 Oct;9(5):1853-1868. doi: 10.1007/s13300-018-0469-2. Epub 2018 Jul 24.

Authors

Bashair M Mussa¹, Rifat A Hamoudi², Salah E Abusnana³

Affiliations

¹ Basic Medical Science Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates. bmussa@sharjah.ac.ae.
² Clinical Science Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
³ Clinical Science Department, College of Medicine, University Hospital Sharjah, Sharjah, United Arab Emirates.

Abstract

Introduction: Diabetes mellitus (DM) is associated with multiple complications, including cardiovascular diseases. Previously, it was believed that the latter are mainly caused by hypertension and increased systolic blood pressure. However, recent studies have challenged this concept, by showing that diastolic dysfunction may also be involved in the cardiovascular events that are associated with DM. Pharmacologic management of hypertension in patients with type 2 DM appears to adversely influence diastolic function.

Methods: Four hundred and eight medical records of hypertensive and obese Emirati patients with type 2 DM were included in the present retrospective study. The main objectives of the present study were (1) to determine the prevalence of low diastolic blood pressure (DBP) and diastolic hypotension in this group of patients and (2) to investigate the associations, if any, between the use of various antihypertensive medications and low DBP and diastolic hypotension.

Results: The results of the present study showed that low DBP (< 70 mmHg) was experienced by 40% of the hypertensive type 2 DM patients, whereas diastolic hypotension (< 60 mmHg) was reported to occur in about 10% of the patients. Another important factor that has been significantly correlated with diastolic hypotension is age (p < 0.01). Association trends have been reported between low DBP and diastolic hypotension and several antihypertensive therapies, including (1) monotherapies such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), (2) dual therapies such as ACE inhibitors in combination with thiazide-like diuretics (THLDs) or beta blockers, and (3) triple therapy combinations of ACE inhibitors with THLDs and potassium-sparing diuretics.

Conclusion: The use of antihypertensive medications, in particular ACE inhibitors and ARBs, appears to be a risk factor for the development of low DBP and diastolic hypotension in obese hypertensive Emirati patients with type 2 DM, whereas calcium channel blockers seem to be a safer option for this group of patients.

Keywords: Angiotensin II receptor blocker; Angiotensin-converting enzyme inhibitors; Antihypertensive medications; Calcium channel blockers; Diastolic blood pressure; Diastolic hypotension; Systolic blood pressure; Type 2 diabetes.