Section VII: Summary New focus on treating hypertension beyond the numbers Content Points: In view of current clinical understanding of the link between hypertension and endothelial function, it is important to be aggressive in treating blood pressure elevation. Individual treatment regimens should be directed toward attainment of blood pressure goals such as those delineated in the JNC VI guidelines.106 The clinical challenge is to treat the underlying disease process of hypertension to reduce morbidity and mortality from CHD and CVD.

Over past 2 decades mortality has increased in people with diabetes Content Points: The patient populations examined in this study were the first National Health and Nutrition Examination Survey (NHANES I) and the NHANES I Epidemiologic Follow-up Survey (NHEFS). NHANES I was conducted from 1971 to 1975 and had a cohort of 10 649 individuals, including 670 with diabetes. NHEFS had a cohort of 9233 that included 637 people with diabetes. This survey was conducted from 1982 to 1984.125 The age-adjusted relative risk for mortality is higher in the NHEFS cohort compared with the NHANES I cohort for both men and women with diabetes. This elevation in mortality risk includes death from all causes, heart disease and ischemic heart disease. Risk of death for women appears to have increased more than the risk of death for men during the time periods surveyed. Early, appropriate treatment is necessary to prevent mortality from CVD in people with diabetes. Over time, a more aggressive treatment strategy could bring mortality in diabetics in line with that in nondiabetics.

CDS: Taking the treatment challenge to the next level Content Points: CDS, the combination of diabetes, hypertension and dyslipidemia leads to a high mortality rate from CVD and CHD. Preventing high death rates and impaired quality of life requires early diagnosis of disease. The next step is aggressive reduction of blood glucose and lipid levels as well as blood pressure levels. As shown by the NHANES data presented earlier, clinicians are not yet fully integrating national guidelines into their treatment regimens. A greater awareness and understanding of CDS, the disorders that constitute the syndrome and their underlying pathologies could substantially improve clinical outcomes. Treatments should target these underlying pathologies for maximum effectiveness.