Controlling hypertension in diabetes.

Patients with type 2 diabetes are especially vulnerable to both large and small vessel injury from elevated arterial blood pressure. The frequent combination of hypertension and diabetes is, therefore, associated with a high risk of cardiovascular events and end-stage renal disease. The beneficial therapeutic effects of angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), and other antihypertensive drugs in patients with type 2 diabetes have been well established in placebo-controlled trials, and there appears to be no evidence of differences between treatment regimens based on different drug classes. In addition, a number of major clinical trials have supported a policy of aggressive blood pressure lowering in patients with type 2 diabetes. In the UK Prospective Diabetes Study, for example, tight control of blood pressure was demonstrated to produce clinically important reductions in the risk of complications related to type 2 diabetes compared with less tight control. In most hypertensive patients, however, a reduction to a recommended level <130/85 mm Hg is unlikely to be achieved by monotherapy. Consequently, the combination of ACE inhibitors with other first-line drugs, such as CCBs, diuretics and beta-blockers, is recommended for the therapeutic management of hypertensive diabetic patients.