Which antihypertensive drug combinations are recommended for treatment of hypertension (high blood pressure) in patients with diabetes?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Two or more antihypertensive drugs at maximal doses should be used to achieve optimal BP targets in patients with diabetes and hypertension. [71] Either an ACEI or an ARB is usually required in patients with diabetes and hypertension. If the patient cannot tolerate one class of drugs, the other should be tried. If needed to achieve BP goals, a thiazide diuretic is indicated for those patients with an estimated GFR of 30 mL/min/1.73 m2 or greater, and a loop diuretic is indicated for those with an estimated GFR of less than 30 mL/min/1.73 m2. Regardless of which antihypertensive drugs are used, kidney function and serum potassium levels should be monitored. [71]

In a subgroup analysis from the TRINITY study (TRI ple therapy with olmesartan medoxomil, amlodipine, and hydrochlorothiazide in hypertesive patiens studY), Chrysant et al reported that in patients with hypertension and diabetes, triple-combination drug therapy resulted in greater BP reductions and BP-goal achievement (< 130/80 mm Hg) than dual-combination drug therapy. The triple-combination regimen consisted of olmesartan medoxomil, 40 mg; amlodipine besilate, 10 mg; and hydrochlorothiazide, 25 mg.

Ruggenenti et al found that in patients with type 2 diabetes who have hypertension, combined manidipine and delapril therapy helped improve health in patients with cardiovascular disease, retinopathy, and neuropathy, as well as stabilized insulin sensitivity. [92] However, neither of these agents are available in the US.

A randomized, placebo-controlled study of 119 patients demonstrated that adding spironolactone to existing treatment in patients with resistant hypertension and diabetes mellitus significantly lowered blood pressure. Systolic and diastolic blood pressure were each significantly reduced in the spironolactone group and unchanged in the placebo group at 4 months. [93]

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