The therapy of aged diabetic hypertensives

The great prevalence and incidence of non-insulin dependent diabetes mellitus (NIDDM) and hypertension in the elderly represent several therapeutic problems. Due to aged-related changes in glucose handling and cardiovascular functions which occur with advancing age, it is necessary to treat aged diabetic hypertensive patients with drugs lowering arterial blood pressure but without side effects on glucose metabolism. Non-pharmacological and pharmacological protocols can be taken into account. With regard to the non-pharmacological therapy, a decline in body fatness, an increase in body fitness and an appropriate dietary assumption of sodium, potassium, calcium and magnesium are the most important approach. As far as the therapeutic approach, calcium channel blockers and angiotensin converting enzyme (ACE)-inhibitors seem to be particularly useful in the treatment of aged diabetic hypertensive patients. Calcium channel blockers have no effects on glucose tolerance while they are very effective on heart beating and arterial blood pressure. ACE-inhibitors lowers arterial blood pressure, delay the progression of diabetic nephropathy to the renal failure and, have null or beneficial effects on glucose handling. In conclusion, in aged diabetic hypertensive patients non-pharmacological therapy should be combined to administration of calcium channel blockers and ACE-inhibitors.