The first speaker Professor J Tuomilehto (Helsinki, Finland) showed the relationship between diabetes and the development of cardiovascular disease and the growing role of type 2 diabetes. After age of 70 years the majority of Europeans have type 2 diabetes or impaired glucose tolerance.
There is a close relationship between type 2 diabetes, obesity and hypertension in males. In females diabetes is associated with hypertension independent of obesity. Incidence of CV disease is 3 to 4 times higher in diabetics compared to non-diabetics. 1 mmol/L of 2 hour PG corresponds to 7 mmHg of SBP related to all-cause mortality. It is being considered to lower the diagnostic cut-off for hypertension in diabetics to 130/80 mmHg.
The second speaker Professor A M Heagerty (Manchester, GB), showed that the structural changes that can be seen in resistant vessels in essential hypertension would be eutrophic inward remodelling before evidence of target organ damage. In type 2 diabetics the resistance vessels show vascular wall hypertrophy or disordered myogenic response as signs of early damage. There is endothelial impairment even in normotensive diabetics. As a consequence there is arterial stiffening and poor response to pharmacotherapy. It seems that the most beneficial effects of drug treatment could be inhibiting the RAAS system and particularly term treatment.
The third speaker, Professor G Mancia (Monza-Milan, Italy) showed that hypertensives have a much greater risk of developing diabetes when compared to non-hypertensives; this risk is also present in white-coat hypertensives and in masked hypertensives. He pointed out that new hypertensive drugs have anti-diabetic properties compared to old drugs like diuretics and beta-blockers. In an analysis of 130,000 patients this amounted to 8.5% vs. 10.2% over four years.
The mechanisms are multiple and are currently being extensively investigated. Even small doses of diuretics may provoke diabetes in some studies. Predictors of diabetes consistently seem to be high fasting glucose and obesity. Patients with metabolic syndrome have a very high risk of developing diabetes.
The fourth speaker Professor L Ryden (Stockholm, Sweden) explained that the cost of treating diabetics in Europe is estimated to be 29 billion euros per year and 42% of this is hospital care. Diabetics have a clustering of all risk factors. There is solid evidence from trials like HOT and HOPE that high blood pressure should be treated aggressively. Recent data from the TNT study showed that a high dose of statins further decreased cardiovascular events by 25% compared to low dose. Other studies show that multiple interventions in diabetics could halve CV complications.
The recent EURO Heart Survey comprising about 5,000 patients showed gross under treatment of diabetics for hypertension, lipids and glucose control. He concluded that there is huge potential in improving risk factor control in diabetics and reducing the cost for society.