Management of hypertension and diabetes: treatment goals, drug choices, current practice, and strategies for improving care.

Diabetes and hypertension are common coexistent conditions, the combination of which results in an increased risk for cardiovascular and renal disease. Clinical trials have convincingly demonstrated the benefit of tight blood pressure control among patients with diabetes in reducing these risks. Furthermore, the choice of medication is less important than the level of control, especially in patients without renal involvement. Despite widespread dissemination of guidelines advocating tight control, many patients with diabetes continue to have uncontrolled blood pressure. The reasons for this are likely due to two main factors: blood pressure is more difficult to control in patients with diabetes, and providers are not treating these patients aggressively enough. Although the optimal approach to changing provider behavior and improving hypertension control is unknown, it likely involves a multi-faceted intervention that includes a disease management approach and targets multiple barriers to care, including those related to the providers, patients, and the health care organization.