Diabetes mellitus and hypertension: a mandate for intense treatment according to new guidelines.

Diabetics without a prior myocardial infarction have the same risk of a future myocardial infarction as nondiabetics with a prior myocardial infarction; however, epidemiologic studies suggest that lower blood pressure treatment goals may have potential benefit for diabetics with hypertension. Low-dose diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, and dihydropyridine calcium antagonists have reduced cardiovascular events in patients with diabetes. Angiotensin receptor blockers with diabetic renal disease have reduced the rate of end-stage renal disease, whereas dihydropyridine calcium antagonists show no benefit. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers reduce overall mortality, cardiovascular events, and the development of the overt nephropathy in high-risk patients with diabetes without advanced renal disease. The blood pressure treatment goal for patients with diabetes without macroalbuminuria is less than 130/80 mm Hg and less than 125/75 mm Hg for patients with diabetes and nephrotic syndrome. To achieve these goals, multiple antihypertensive drugs are required.