Hypertension in Diabetic Patients

American Family Physician,  Feb 15, 1999  by M.D. Walling, Anne D.

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(Great Britain -- The Practitioner, August 1998, p. 587.) Up to one half of all patients with diabetes also have hypertension, making the prevalence of hypertension in diabetic patients double that of the nondiabetic population. Both large- and small-vessel disease contribute to this increased prevalence of hypertension through a variety of mechanisms, including the secondary effects of nephropathy.

The benefits of controlling hypertension have been clearly demonstrated for both type 1 and type 2 diabetes (formerly known as insulin-dependent and nonEinsulin-dependent diabetes mellitus, respectively). The strongest evidence of benefit is for treatment using angiotensin converting enzyme (ACE) inhibitors in patients with microalbuminuria. Treatment should be directed toward achievement of systolic pressures of 125 to 140 mm Hg and diastolic pressures of 75 to 88 mm Hg. Calcium channel blockers reduce blood pressure and may be particularly effective in patients of African descent, but these drugs have not been shown to reduce microalbuminuria. Alpha-blocking drugs are also effective in lowering blood pressure but have no known renal benefit and may cause postural hypotension. Most of the evidence supporting treatment of hypertension in patients with diabetes is based on studies of patients less than 65 years of age. Research to guide therapy in older diabetic patients with hypertension is limited.

COPYRIGHT 1999 American Academy of Family Physicians
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