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Abstract

Current understanding of the genesis of diabetic vascular disease suggests that vascular complications, such as atherosclerosis and hypertension, are associated with changes in structural and functional parameters. Experimental and epidemiological data suggest that activation of the renin-angiotensin-aldosterone system plays an important role in the development of micro-and macro-vascular complications. Most of the negative cardiovascular actions of angiotensin II are mediated through AT 1 receptors, whereas the AT 2 receptors mediate largely beneficial effects. Hence, compared to angiotensin converting enzyme inhibitors (ACEIs), selective AT 1 receptor blockers (ARBs) should provide additional end organ protection via AT 2 receptors activation. Although ACEIs are useful therapeutically, they are being currently displaced by ARBs.Enhanced calcium ion channel activity is reported in vascular smooth muscles from diabetic animal models. Clinical benefits of calcium channel blockers (CCBs) in diabetic hypertensive patients are controversial, but there is increasing experimental evidence for the beneficial effects of dihydropyridine-type CCBs. Although the treatment of hypertension in diabetics reduces cardiovascular and microvascular complications, the ideal strategy for treating hypertension in diabetics has not been well defined and warrants a combination approach. Only limited clinical data regarding the use of ARBs in combination with CCBs in diabetics are available. The experimental data suggest that combination of a CCB and an AT 1 receptor blocker, or a hypothetical dual blocker of AT 1 receptors as well as of calcium channels would be an ideal regimen. There is, however, no conclusive 99