[Principles of hypotension treatment in patients with diabetes]

Epidemiological studies have revealed, that elevated blood pressure is in diabetics 1.5-3.0-times more frequent that in general population. It is one of the most important factors increasing the morbidity and mortality due to small and big arteries disease. Hypotensive therapy should be commenced in diabetic persons earlier than in patients without diabetes mellitus. In many such diabetic patients blood pressure normalization could be obtained by dietary adaptations and metabolic compensation. In more advanced cases pharmacological treatment should be undertaken. When selecting the drug for a diabetic person one has to balance between positive and adverse actions. The drugs of the first choice are the ACE inhibitors, drugs blocking the slow calcium channel and alpha 1-adrenergic receptors, because they do not influence negatively the carbohydrate and lipid metabolism. On contrary, prazosin and ACE inhibitors increase the tissue sensitivity to insulin. The latter group decrease also intraglomerular pressure and albuminuria. As a routine the treatment begins with small, testing dose of a single hypotensive drug. The dosage may be increased slowly up to the average dose level. If this manipulation does not permit normalization of blood pressure one may combine 2 or 3 hypotensive drugs. Selection of the drug and of its dose rely also on the type and intensity of late diabetic complications--at first nephropathy and autonomic neuropathy.