Treatment of Hypertensive Diabetic Patients

Abstract

This article briefly reviews the literature on the incidence of hypertension in the diabetic population, the risks associated with this combination of conditions, and the nonpharmacologic and other therapies available to lower blood pressure in these patients. Although several studies of nonpharmacologic therapies and diuretics are considered, the emphasis is on the reported advantages and disadvantages of p-blockers, centrally acting agents, a-adrenergic-blocking agents, calcium-channel blockers, and angiotensin-converting enzyme inhibitors. Diabetes Care 11:828-32, 1988 A lthough the incidence of high blood pressure in the diabetic population is not precisely known, it appears to be considerably higher than that in the nondiabetic population (1-4). When adjustments are made for the effect of age, the prevalence of hypertension is relatively higher in those with type I (insulin-dependent) than in those with type II (non-insulin-dependent) diabetes (5). Coexisting hypertension and diabetes act as additive risk factors to accelerate vascular complications. The Framingham study found that the risk of cardiovascular disease is higher in diabetic patients, especially diabetic women; the impact was greatest for intermittent claudication and congestive heart failure and less noticeable in coronary artery disease. The Whitehall study, however, demonstrated that the risk for coronary artery disease is higher in hypertensive than in normotensive diabetic patients (6).