How to treat the diabetic hypertensive individual appropriately.

ASSOCIATION OF HYPERTENSION AND DIABETES

Diabetes mellitus and arterial hypertension are closely related and strongly predispose an individual to atherosclerosis and renal failure. Hypertension is twice as frequent in diabetic individuals as it is in the general population, and often precedes the development of diabetic nephropathy. The prevalence of coexisting arterial hypertension and non-insulin-dependent diabetes mellitus is increasing because of ageing of the population, allowing an augmented prevalence of atherosclerosis and end-stage diabetic renal disease. ANTIHYPERTENSIVE TREATMENT OF DIABETIC PATIENTS: The goal of blood pressure control in diabetic patients is to reduce death and disability as much as possible. In addition, other reversible risk factors for cardiovascular disease, which are so frequently seen in hypertensive diabetic individuals, need to be addressed. The optimal blood pressure level in diabetic individuals has not yet been established, but it has been suggested that it be should lower than that recommended by current guidelines. In fact, the literature indicates that 130/85 mmHg should be the systolic/diastolic blood pressure goal in hypertensive diabetic individuals. According to most guidelines the threshold for intervention when multiple associated risk factors coexist with hypertension is a blood pressure level 140/90 mmHg. In diabetic patients therapy has to be instituted early and aggressively. In this regard, angiotensin converting enzyme inhibitors alone or in association with other drugs seem to be the best choice for hypertensive diabetic patients.