Treatment of hypertension in diabetic patients.

There is increasing evidence that a slight elevation of blood pressure values may have a deleterious effect on diabetic angiopathy. Hypertensive diabetic patients are prone to suffer clinical and/or biological side effects of antihypertensive agents. More recently calcium antagonists and angiotensin converting enzyme inhibitors have proved effective and better tolerated in hypertensive diabetic patients. New data from the literature and from our group are reviewed. In patients with incipient or clinical nephropathy, angiotensin converting enzyme inhibition reduces urinary albumin excretion and preserves glomerular filtration rate. The effects of treatment of hypertension on blood pressure control obtained in small groups of selected and motivated patients are at variance from those obtained in routine practice. Poor compliance is the major problem in hypertensive diabetic patients. The rationale exists to provide early aggressive antihypertensive treatment in this population but we must develop new drugs that are more effective and better tolerated. We have also to improve health care delivery, information and education for these patients.