Treating hypertension in the diabetic patient: therapeutic goals and the role of calcium channel blockers.

Although many drugs effectively control hypertension in patients with diabetes mellitus, the risk of aggravating the diabetic process and inducing new complications can negate the benefits of reduced blood pressure. This article discusses the current status of antihypertensive therapy in diabetic patients and focuses on the use of calcium channel blockers that safely reduce blood pressure while having a neutral or beneficial effect on the diabetic state and related medical complications. While both calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors are suitable agents for the primary treatment of diabetic hypertension, the beneficial effects of calcium channel blockers on glucose homeostasis, lipid metabolism, and renal function support their routine use as alternatives to ACE inhibitors. Among the three classes of calcium channel blockers, second-generation dihydropyridines offer advantages over older calcium channel blockers because the second-generation drugs provide greater vascular selectivity and less direct myocardial depression.