Selection of antihypertensive agents in patients at risk for diabetes

Type 2 diabetes mellitus (DM2) has increased 41% in the United States, with an estimated one third undiagnosed and another 41 million with prediabetes. Hypertension affects 20% to 60% of all diabetics, contributing to up to 75% of deaths due to cardiovascular disease. These staggering statistics make it imperative that hypertensive patients who are at risk for DM2 are identified and treated early. Numerous studies have been done involving choice of antihypertensive in established diabetics, and a slowing or halting of the progression in the development of diabetes in these patients has been noticed. However, to date, nothing is conclusive. For now, following the JNC 7 guidelines of using a diuretic as monotherapy or in combination with an angiotensin-converting enzyme inhibitor (ACEI), angiotensin II-receptor blocker (ARB), beta-blocker, or calcium channel blocker may be prudent. Two current studies, the DREAM trial and the ONTARGET trial, may shed more light as to whether ACEIs or ARBs have a preferred niche in initial treatment of the hypertensive patient who is at risk for diabetes.