How to treat hypertension in diabetic patients

The coexistence of hypertension in a patient with diabetes presents a therapeutic challenge. Attempts to favorably influence cardiovascular risk factors related to atherosclerosis - stroke, cardiac failure, peripheral arterial disease, and coronary artery disease - are confounded by the metabolic effects of diabetes and its renal complications. Early identification of patients at risk for diabetic nephropathy and initiation of antihypertensive treatment may markedly improve morbidity and mortality in these patients. Antihypertensive drugs for patients with diabetes should be chosen carefully. Although most are effective, many have metabolic effects that can offset much of the benefit of lowered blood pressure. Of particular concern with thiazide diuretics and beta-adrenergic blocking agents are their effects on glycemic control and lipid status, two major atherogenic risk factors. Other antihypertensive drugs have characteristics that may adversely impact the patient's quality of life. Angiotensin converting enzyme (ACE) inhibitors, calcium-entry blockers, and alpha₁-adrenergic blocking agents effectively reduce blood pressure and have little impact on insulin secretion and glycemic control. These agents do not adversely influence subclinical autonomic neuropathy, nor do they increase cardiovascular risk factors by elevating atherogenic lipid components. Independent of these effects, preliminary findings in hypertensive diabetic patients with nephropathy suggest that renal function may be protected through the action of ACE inhibition on intrarenal hemodynamics.