Treatment of hypertension in patients with type 2 diabetes

Zygmunt Chodorowski, Jacek Sein Anand

Summary
Antihypertensive therapy in diabetics is highly effective in reducing cardiovascular and microvascular complications. However, many patients require three or more drugs to achieve blood pressure below 130/80 mmHg. It seems reasonable to use angiotensin-converting enzyme (ACE) inhibitors as the first-line agent in most diabetics, especially in patients with type 2 diabetes, hypertension and/or microalbuminuria. In diabetics with hypertension, proteinuria or renal insufficiency, angiotensin receptor blockers (ARBs) are considered first-line therapy. If ACE inhibitors or ARBs are not well tolerated by patients due to the renal complications, the use of â-blockers or non-dihydropyridine calcium channel blockers (non-DCCB), often with thiazide diuretics, should be considered. In patients with a recent myocardial infarction, â-blockers should also be considered. DCCBs and a-blockers can be used as second-line drugs.

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