Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Kaplan, N. M.    Related Articles in PubMed    PubMed Citation    PubMed

PERSPECTIVE

Management of Hypertension in Patients with Type 2 Diabetes Mellitus: Guidelines Based on Current Evidence

Norman M. Kaplan, MD

18 December 2001 | Volume 135 Issue 12 | Pages 1079-1083

Hypertension and diabetes are becoming increasingly common. Most patients with both disorders have a markedly worsened risk for premature microvascular and macrovascular complications. The appropriate management of the hypertension seen in almost 70% of patients with type 2 diabetes mellitus remains controversial. However, over the past few years, many randomized, controlled trials have provided guidance for more effective therapy. These trials have established the need for a lower goal blood pressure (<130/80 mm Hg) than has previously been recommended. In addition, they have proven the efficacy of drugs from three major classes of antihypertensive agents; however, comparative trials have failed to show definite superiority of any particular class in either lowering blood pressure or reducing cardiovascular morbidity and mortality.

To achieve therapy goals, multiple antihypertensive drugs are usually needed. On the basis of their apparent superiority in slowing diabetic nephropathy, angiotensin-converting enzyme inhibitors should probably be the first choice. Second and third choices should be a long-acting diuretic and a calcium-channel blocker or a ß-blocker, respectively. Attention should also be directed toward nonpharmacologic and pharmacologic control of hyperglycemia and dyslipidemia.

Author and Article Information

From University of Texas Southwestern Medical Center, Dallas, Texas.

Requests for Single Reprints:

Norman M. Kaplan, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8899.

Related articles in Annals:

Perspectives
Clinical Implications of Recent Findings from the Antihypertensive and Lipid-Lowering Treatment To Prevent Heart Attack Trial (ALLHAT) and Other Studies of Hypertension
Curt D. Furberg, Bruce M. Psaty, Marco Pahor, AND Michael H. Alderman

Annals 2001 135: 1074-1078. [ABSTRACT][Full Text]  

Editorials
Sound Clinical Advice for Hypertensive Patients
Cynthia Mulrow

Annals 2001 135: 1084-1086. [Full Text]  

This article has been cited by other articles:

				J. G. Ray, M. J. Vermeulen, and G. Koren Taking ACE inhibitors during early pregnancy: Is it safe? Can Fam Physician, September 1, 2007; 53(9): 1439 - 1440. [Abstract] [Full Text] [PDF]

				J. M. Robbins and D. A. Webb Hospital Admission Rates for a Racially Diverse Low-Income Cohort of Patients With Diabetes: The Urban Diabetes Study Am J Public Health, July 1, 2006; 96(7): 1260 - 1264. [Abstract] [Full Text] [PDF]

				A. Cotton, C. B. Aspy, J. Mold, and H. Stein Clinical Decision-Making in Blood Pressure Management of Patients with Diabetes Mellitus: An Oklahoma Physicians Resource/Research Network (OKPRN) Study. J Am Board Fam Med, May 1, 2006; 19(3): 232 - 239. [Abstract] [Full Text] [PDF]

				S. M. Grundy Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1093 - 1100. [Abstract] [Full Text] [PDF]

				M. Ravera, E. Ratto, S. Vettoretti, D. Parodi, and G. Deferrari Prevention and Treatment of Diabetic Nephropathy: The Program for Irbesartan Mortality and Morbidity Evaluation J. Am. Soc. Nephrol., March 1, 2005; 16(3_suppl_1): S48 - S52. [Abstract] [Full Text] [PDF]

				A. F. Rubio-Guerra, A. Arceo-Navarro, G. Vargas-Ayala, L. Rodriguez-Lopez, J. J. Lozano-Nuevo, and C. T. Gomez-Harper The Effect of Trandolapril and Its Fixed-Dose Combination With Verapamil on Proteinuria in Normotensive Adults With Type 2 Diabetes Diabetes Care, July 1, 2004; 27(7): 1688 - 1691. [Abstract] [Full Text] [PDF]

				E. J. Lewis and J. B. Lewis ACE Inhibitors versus Angiotensin Receptor Blockers in Diabetic Nephropathy: Is There a Winner? J. Am. Soc. Nephrol., May 1, 2004; 15(5): 1358 - 1360. [Full Text] [PDF]

				G. Deferrari, M. Ravera, V. Berruti, G. Leoncini, and L. Deferrari Optimizing Therapy in the Diabetic Patient with Renal Disease: Antihypertensive Treatment J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S6 - 11. [Abstract] [Full Text]

				L. M Ruilope, J. Segura, and E. L Schiffrin Review: ACE inhibition or angiotensin receptor blockade: which should we use in diabetic patients? Journal of Renin-Angiotensin-Aldosterone System, June 1, 2003; 4(2): 74 - 79. [Abstract] [PDF]

				C. E. Mogensen, G. Viberti, S. Halimi, E. Ritz, L. Ruilope, G. Jermendy, J. Widimsky, P. Sareli, J. Taton, J. Rull, et al. Effect of Low-Dose Perindopril/Indapamide on Albuminuria in Diabetes: Preterax in Albuminuria Regression: PREMIER Hypertension, May 1, 2003; 41(5): 1063 - 1071. [Abstract] [Full Text] [PDF]

				T. Berl, L. G. Hunsicker, J. B. Lewis, M. A. Pfeffer, J. G. Porush, J.-L. Rouleau, P. L. Drury, E. Esmatjes, D. Hricik, C. R. Parikh, et al. Cardiovascular Outcomes in the Irbesartan Diabetic Nephropathy Trial of Patients with Type 2 Diabetes and Overt Nephropathy Ann Intern Med, April 1, 2003; 138(7): 542 - 549. [Abstract] [Full Text] [PDF]

				G. Deferrari, M. Ravera, L. Deferrari, S. Vettoretti, E. Ratto, and D. Parodi Renal and Cardiovascular Protection in Type 2 Diabetes Mellitus: Angiotensin II Receptor Blockers J. Am. Soc. Nephrol., November 1, 2002; 13(90003): S224 - 229. [Abstract] [Full Text]

				C. Mulrow Sound Clinical Advice for Hypertensive Patients Ann Intern Med, December 18, 2001; 135(12): 1084 - 1086. [Full Text] [PDF]