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The diabetic patient with hypertension

G P Leese1, M W Savage, P D Chattington

  • 1Ninewells Hospital, Dundee, UK.

Postgraduate Medical Journal
|May 1, 1996
PubMed

Insights

Managing hypertension in diabetic patients is crucial for slowing kidney function decline and reducing cardiovascular risks. Aggressive blood pressure control is recommended, with specific drug classes offering additional benefits for kidney and metabolic health.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Hypertension and diabetes frequently coexist, increasing cardiovascular and renal risks.
  • Diabetic renal disease, detectable by microalbuminuria, is a common complication.
  • Ambulatory blood pressure monitoring can reveal nocturnal dipping loss, missed by standard measures.

Purpose of the Study:

  • To review the management of hypertension in patients with diabetes.
  • To highlight the importance of aggressive blood pressure control in preserving renal function.
  • To discuss the cardiovascular and metabolic effects of various antihypertensive drugs.

Main Methods:

  • Review of current literature on hypertension and diabetes management.
  • Analysis of cardiovascular events and renal function in relation to blood pressure.
  • Evaluation of antihypertensive drug classes and their impact on metabolic parameters and left ventricular hypertrophy.

Main Results:

  • Aggressive hypertension treatment is vital for slowing glomerular filtration rate decline.
  • No 'J'-shaped curve observed for blood pressure and cardiovascular events in diabetics, supporting lower targets.
  • Angiotensin-converting enzyme inhibitors offer renoprotective benefits.
  • Non-dihydropyridine calcium antagonists are preferred over dihydropyridines due to potential proteinuria augmentation.
  • Alpha-adrenergic antagonists may improve lipid profiles; beta-blockers and thiazide diuretics can negatively impact glycemic and lipid profiles.

Conclusions:

  • Effective hypertension management is essential for reducing morbidity and mortality in diabetic patients.
  • Drug selection should consider effects on renal function, cardiovascular health, and metabolic parameters.
  • ACE inhibitors and non-dihydropyridine calcium antagonists are favorable choices, while beta-blockers and thiazides require careful consideration.

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