Do angiotensin converting enzyme inhibitors represent a progress in hypertension care in diabetes mellitus?

Abstract

Obviously, the introduction of new antihypertensive drugs, as promising they may ever be, will by itself not lead to an improvement of the overall quality of hypertension care in diabetic patients. Rather, the standards of hypertension care in unselected patient populations will depend (on the part of physicians) on systematic attempts to diagnose early and to initiate effective therapy, and (on the part of patients) on adherance to agreed therapeutic procedures [26]. In contrast to the tremendous interest in new pharmaceutical principles in antihypertensive therapy, surprisingly few attempts have been directed towards assessment and improvement of overall quality of hypertension care in diabetic patients. The few available data indicate very infrequent blood pressure measurements in diabetic patients both in general practitioners' offices and in diabetes centres [45, 46], and high percentages of patients with either untreated hypertension [47] or insufficient blood pressure control despite treatment [26, 46]. These problems are most unlikely to be solved by the mere introduction of ACEIs or any other new antihypertensive drug. One may even fear that the emphasis on promoting such new, still incompletely evaluated drugs may detract physicians and patients from the necessity to comply to tedious rules of long-term hypertension care using well established therapeutic principles. On the other hand, one might hope that the present most active marketing campaign for ACEIs will foster the interest for the real problems of hypertension care in diabetes. In this indirect way, the ACEIs may indeed contribute to the urgently needed improvement of hypertension care in diabetic patients.