Trends in hypertension treatment in diabetes.

This review discusses current concepts and future trends in the optimal control of elevated blood pressure and hypertension in persons with diabetes, specifically type 2 diabetes mellitus. Although the primary management for persons with type 2 diabetes mellitus, especially with lower levels of blood pressure elevation, is modification or reversal of adverse lifestyles, including weight management and increased physical activity, pharmacologic antihypertensive treatment is usually necessary to optimally control cardiovascular and renal risks. Therapies that modulate the renin-angiotensin-aldosterone system may be beneficial in reducing associated cardiovascular and renal diseases, but control of elevated blood pressure remains an essential target of any antihypertensive therapy. Blood pressure goal attainment, even with pharmacologic therapy, is distressingly low. Certain racial or ethnic groups in the United States have a higher prevalence of diabetes, and greater associated rates of hypertension are noted in African Americans, with increased cardiovascular morbidity and mortality. Clinical evidence may soon confirm or refute the outcomes benefit of blood pressure targets of 120/80 mm Hg or lower.