Treatment of Hypertension in Diabetes

What Is the Best Therapeutic Option?

Tonje A Aksnes; Sigrid N Skårn; Sverre E Kjeldsen

Disclosures

Expert Rev Cardiovasc Ther. 2012;10(6):727-734. 

In This Article

Conclusion

Early detection and treatment of risk factors may decrease the chance of developing cardiovascular disease. Diabetes mellitus is a major cause of cardiovascular disease, and efforts to reduce cardiovascular risk by targeting the fundamental abnormality in diabetes through intensive glucose lowering have only produced modest benefits and may carry some risk such as hypoglycemic episodes, necessitating alternative strategies. Diagnosing and treating hypertension is particularly important in diabetic patients both to prevent macrovascular disease and to minimize progression of microvascular complications, such as renal disease and diabetic retinopathy. In view of the predicted increase in the number of diabetic patients during the coming decades,[37] it is of great importance from both a medical and an economical perspective to reduce the healthcare burden with focus on prevention, early detection and treatment of both diabetes and comorbidities. Good BP control and optimizing other cardiovascular risk factors may also reduce the total cardiovascular risk of the patients. Lifestyle interventions should be encouraged in all patients, with particular attention to weight loss and reduction of salt intake. There is no clear optimal target BP in diabetic patients with hypertension. Goal BP should be well below 140/90 mmHg, close to 130/80 mmHg, but not below these values. The evidence for a lower target is scarce and has never really been achieved in any single large trial. Diuretics, β-blockers, CCBs, ACEis and ARBs can all be used; however, a combination of two or more drugs is often needed. Lowering BP also exerts a renal protective effect (reducing microalbuminuria). Moreover, some additional protection may be obtained by the use of a blocker of the RAS (ARB and ACEi), and a blocker of the RAS should be a regular component of combination treatment and the one preferred when monotherapy is sufficient. The RAS blocker – CCB combination has been shown to be effective by the ACCOMPLISH trial. Treatment strategies should also consider an intervention against all cardiovascular risk factors, such as lipid lowering, smoking cessation and normalization of hyperglycemia.

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