[Antihypertensive therapy in patients with diabetes mellitus]

A relative systemic hyperinsulinism, sodium retention as well as an increased cardiovascular reactivity to norepinephrine and angiotensin II in diabetics may explain the prognostically unfavorable frequent association of diabetes with high blood pressure. The first therapeutic approach against hypertension is omission of smoking and exaggerated alcohol consumption as well as of drugs which elevate blood pressure. An attempt to reach a normal body weight by means of a sodium restricted diabetes-diet is next. If blood pressures remain elevated an antihypertensive drug is prescribed in monotherapy, nowadays preferably a calcium antagonist or an ACE-inhibitor, because both of them cause few side effects, do not impair glucose and lipid homeostases and are easy to handle with a once-a-day regimen. A therapeutic algorithm is presented and consideration of the total risks of morbidity and mortality in these patients stressed.