Hypertension in patients with diabetes mellitus: treatment with a centrally acting agent

This retrospective study was undertaken to evaluate the effectiveness and clinical characteristics of guanabenz, a centrally acting agent, as monotherapy in hypertensive patients with coexisting diabetes mellitus. Of 113 patients with data available for analysis, 21 were receiving concurrent therapy with insulin, 31 were receiving oral hypoglycemic agents, and 61 were being treated by a diabetic diet alone. During treatment with guanabenz (4-64 mg daily) for up to 2 years (mean duration, 7 months), diastolic blood pressure (measured in the supine posture) decreased by an average of 10 mm Hg; the effects were similar among the three subgroups of patients receiving the different diabetic therapies. Clinically satisfactory treatment outcomes occurred in 52%, 77%, and 57% of patients, respectively. Body weight remained constant throughout the study. The antihypertensive efficacy of guanabenz in this study and the nature and frequency of side effects produced were similar to those reported previously in nondiabetic hypertensive patients. Neither plasma glucose concentrations nor the diabetic therapy requirements of the diabetic patients in this study were altered by guanabenz treatment. There also was a small decrease in serum total cholesterol concentration (mean decrease, 15 mg/dl, p less than 0.001) during the study. Thus, antihypertensive monotherapy with guanabenz is effective in the treatment of a majority of patients with coexisting diabetes mellitus. Since it does not appear to interfere with the concurrent treatment of diabetes or cause unwanted metabolic side effects, guanabenz may be a rational and safe agent for the management of hypertension in the diabetic patient.