[Treatment of hypertensive type 2 diabetics: too late, too little]

The coexistence of hypertension and type 2 diabetes considerably increases the risk for cardiovascular and renal complications, not only after manifestation of the diseases, but also in the range of high-normal blood pressures and prediabetic states. According to recent guidelines, patients with type 2 diabetes should be treated if the blood pressure is in the high-normal (previously normal) range (130-139/85-90 mmHg), sometimes even with blood pressures in the normal oder low prehypertensive range (120-129/80-85 mmHg). In any case, blood pressure should be reduced < 130/80 mmHg, if tolerated < 125/75 mmHg. The target for diabetic patients with microalbuminuria or nephropathy is below 125/75 mmHg. All blood pressure goals cited refer to office or clinic blood pressure measurements. The corresponding values for home (self) or ambulatory blood pressure measurement during the day are lower by 5-10 mmHg for systolic and 5 mmHg for diastolic blood pressures. The proper management of patients with type 2 diabetes has to be multifactorial, aiming at controlling blood pressure, hyperglycemia and dyslipidemia by using both lifestyle changes (reduction of sodium and fat intake, regular physical activity, weight loss in overweight patients, smoking cessation) and drug therapy. Antihypertensive treatment should be started with a (fixed) combination, preferably containing an inhibitor of the renin-angiotensin system such as ACE inhibitors or AT(1)-receptor blockers and either a diuretic (preferably indapamide) or a calciumantagonist rather than combining thiazide diuretics and beta-blockers.