Hypertension in diabetes: optimal pharmacotherapy

Hypertension is commonly associated with diabetes mellitus. The combination of hypertension with obesity and diabetes is a well recognized entity known as the metabolic syndrome, which shares a common pathophysiology of insulin resistance. The individual components of this syndrome act synergistically to substantially increase the risk of renal disease, stroke, coronary artery disease, and death. Hypertension increases both macrovascular and microvascular complications of diabetes such as neuropathy, nephropathy, coronary artery disease, stroke, and retinopathy. Hence there is a pressing need to achieve good control of hypertension to reduce such complications. Studies have been conducted to define target blood pressure in order to minimize such complications and also to decide on the type of drugs most likely to reduce complications/adverse events among diabetics. Along with the trusted and proven therapies to control blood pressure in diabetes, efforts should also be underway to define the hitherto unknown factors contributing to this problem and the ways to control them. There is also a need to prevent the development of diabetes among those predisposed to it and a defined approach needs to be established.