Hypertension in the diabetic patient. Selection and optimum use of antihypertensive drugs.

Understanding of the pathophysiology of hypertension and diabetes mellitus and their association is at present fragmentary at best. Optimal antihypertensive drug therapy of patients with both disorders is therefore based on limited experimental data, practical experience and educated guesswork, and needs to be tailored to each (often multimorbid) individual. In most patients monotherapy would be preferred, and would begin with a calcium antagonist or a converting enzyme inhibitor at a low to moderate dosage. If this is not effective an alpha 1-adrenoceptor inhibitor, a cardioselective beta-blocker or a diuretic, always at a low to moderate dosage, should be tried. If still unsuccessful, low dose combinations of 2 of these drugs are next. The (long term) regimen should be as simple as possible, and its effects--desired and undesired--monitored as closely as the carbohydrate disorder.