A Guide to the Management of Blood Pressure in the Diabetic Hypertensive Patient

Abstract

Diabetes mellitus and hypertension frequently coexist in patients with the insulin resistance syndrome (IRS). Patients with both diabetes and hypertension typically have widespread endothelial dysfunction, increased oxidative stress, an activated sympathoadrenal system, and an elevated systemic burden of inflammatory mediators. Patients with diabetes and hypertension also have concomitant mixed dyslipidemia and obesity with significant frequency, and are at high risk for the development of macro- and microvascular disease, congestive heart failure, and nephropathy. Current data suggest that ACE inhibitors or angiotensin receptor blockers with or without a diuretic are important, if not preferred, initial therapies for the patient with diabetes and hypertension. Other drug classes such as combined alpha-/beta-adrenoceptor antagonists, dihydropyridine calcium channel antagonists (CCAs), and peripheral alpha-adrenoceptor antagonists are also useful therapeutic options in these patients. In order to optimally reduce the risk for cardiovascular events in the patient with diabetes and hypertension, optimal BP control should be coupled with comprehensive lifestyle modification and aggressive management of dyslipidemia and hyperglycemia.