[Treatment of arterial hypertension in diabetics]

Hypertension occurs frequently in diabetics. In these patients anti-hypertensive treatment is difficult and still imperfectly resolved. The drugs used to treat hypertensive diabetics are the same as those for the non-diabetics, but their side effects are more important in patients with diabetes or impaired glucose tolerance. When hypertension is discovered in a diabetic, the addition of further dietary constraints and drugs often limits compliance with therapy. Diuretics increase orthostatic hypotension which is frequent in diabetics. Their deleterious effects on carbohydrate, lipid and uric acid metabolism are not clearly defined in these patients already at high risk. In diabetics liable to hypoglycaemic attacks, cardioselective beta-blockers are safer to use than non-selective beta blockers. They have considerably improved control of blood pressure, but are not effective in all cases. In addition, their effects on lipoproteins and carbohydrate metabolism require further study. The centrally acting anti-hypertensives and the vasodilators produce side effects which are particularly frequent and undesirable in the diabetic. They are usually used in combination at low dose when the control of blood pressure is not achieved with the use of diuretics and/or beta-blockers. Over the past few years, information concerning the use of the different anti-hypertensive agents in diabetes has accumulated with a resulting improvement in blood pressure control. Normalization of blood pressure is a goal not always reached but necessary if cardiovascular morbidity and mortality, the main problem in diabetics, are to be reduced.