Management of Patients with Diabetes and “Abnormal” Blood Pressure: Selection of Antihypertensive Agents

Abstract

To characterize the association of diabetes and hypertension and to discuss management strategies. Published studies are summarized and various hypotheses are reviewed. Hypertension is a major determinant of the increased cardiovascular, peripheral vascular, and renal complications associated with diabetes. Recent evidence indicates that insulin resistance is one of the multiple key components of the pathophysiologic elements underlying the increased prevalence of hypertension associated with diabetes. In patients with diabetes, management of hypertension is frequently complicated by the coexistence of other macrovascular risk factors, including dyslipidemia, obesity, visceral adiposity, and poor glycemic control. The choice of antihypertensive agents in both type I and type II diabetes must be based on the selective metabolic, hormonal, and hemodynamic advantages and disadvantages of these agents in individual patients. Long-term trials are needed to determine the benefits, if any, of various angiotensin-converting enzyme inhibitors, calcium channel antagonists, and alpha1-adrenergic receptor antagonists in preventing the cardiovascular and the renal complications of diabetes.