Title: Pharmacological treatment of hypertension in diabetes mellitus
- Józef Drzewoski, Leszek Czupryniak
- Editorial article
- Polish Journal of Cardiology
- Start page:
- Final page:
- hypertension, diabetes mellitus, pharmacotherapy
Hypertension is frequently associated with diabetes mellitus and substantially increases the risk of cardiovascular complications. As the mechanisms underlying the association between diabetes and hypertension are still unclear, significant therapeutic problems are common. High blood pressure is found in 40% of patients with 20 years history of type I diabetes. In type II diabetes, 40% of patients aged 45 and 60% of patients aged 75 present with hypertension. Management of hypertension in diabetes involves both pharmacological and non-pharmacological measures. The choice of proper drug treatment should depend upon the recognition of clinical type of diabetes and presence of target organ damage. Understanding of mechanisms of action of antihypertensive drugs is essential. Particular attention should be paid to the impact of drugs on human metabolism. Angiotensin converting enzyme inhibitors are believed to be the drugs of choice in diabetes-associated hypertension. Target blood pressure should be as low as 130/85 mm Hg, particularly in younger patients. The paper reviews the pathophysiology of hypertension in type I and type II diabetes as well as the groups of antihypertensive drugs used in diabetic patients. The latest guidelines (JNC VI Report) and recent results of large prospective trials (UKPDS, HOT) are commented. In conclusion, blood pressure lowering prevents the development of micro- and macrovascular complications. In type II diabetes, effective blood pressure control may lead to even greater reduction in complications risk than blood glucose control.