Antihypertensive drugs and the hypertensive diabetic patient

Hypertension occurs in about 40% of patients with non-insulin-dependent diabetes mellitus (NIDDM) in whom the incidence of coronary heart disease is greatly increased. Disturbances in lipid metabolism may be an important contributory factor. Patterns of lipid change in uncomplicated NIDDM are characterised by a raised serum triglyceride and a reduced high density lipoprotein. It is therefore likely that therapy for hypertension associated with NIDDM may further influence an existing atherogenic lipid profile. Recent studies in diabetic subjects have shown that alpha-blockers are associated with a trend towards improving, while beta-blockers adversely affect, the lipid profile. Calcium antagonists and ACE inhibitors have no adverse effects on the lipid profile.