The importance of blood pressure control in the patient with diabetes.

In individuals with diabetes mellitus, higher risk for renal and cardiovascular disease is seen with blood pressure levels >130/80 mm Hg. Findings of several studies, as well as new guidelines, indicate that individuals with diabetes will benefit from more aggressive treatment of hypertension. Angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, diuretics, beta-adrenoceptor blockers, and calcium-channel blockers are effective antihypertensive agents in type 2 diabetes. Moreover, combinations of these agents are frequently required to reach the target blood pressure of <130/80 mm Hg and reduce risk for renal and cardiovascular events. All of these agents have demonstrated benefits in treating patients. Clinical evidence also indicates that the new vasodilating beta-blockers offer advantages beyond blood pressure control, including cardiovascular risk reduction without exacerbating metabolic parameters. With increased awareness of the need for aggressive treatment of hypertension, clinicians can provide significant benefit to their patients with diabetes. The new beta-blockers may play an important role in achieving blood pressure goals.