Hypertension in type 2 diabetes mellitus: effect of the disease and treatment on development of peripheral artery disease

Coexistence of diabetes and hypertension is well known so as their role as a risk factor for vasculopathy of lower limbs. Ankle brachial index (ABI) offers a simple, fairly reliable mean to quantify this problem. Very few studies in India have assessed the role of angiotensin-converting enzyme inhibitors (ACEI) in preventing vasculopathy in type 2 diabetics. A heterogeneous representative sample of 149 type 2 diabetics (103 ACEI user and 46 non-ACEI user) taking regular pharmacotherapy was tested by ABI using vascular Doppler to assess peripheral artery disease (PAD) following standard protocol. Distribution of risk factors for PAD and ABI values were compared between ACEI user and non-ACEI user diabetics. ABI ≤0.9 was defined as PAD and P value <0.05 considered as statistical significance. ACEI user and non-ACEI user group showed slight difference in prevalence of risk factors for PAD. ACEI user diabetics taking ACEI showed better ABI profile (ABI >0.9) than non-ACEI user diabetics. The non-ACEI user diabetics did not show statistically significant lower ABI difference. But by defining ABI ≤0.9 as PAD, type 2 diabetics not using ACEI proved to be at 2.12 times risk (OR to develop PAD) than those receiving it. Type 2 diabetic hypertensives taking ACEI with strict blood pressure control have an added benefit against PAD along with other established benefits, and the same pharmacotherapy may be used in non-ACEI user diabetics to turn secondary prevention into primary one.