[Treatment of hypertension associated with diabetes mellitus]

The number of patients with non-insulin-dependent-diabetes mellitus (NIDDM) is dramatically increasing in Japan and estimated to be 6 million, more than one of ten adults. It is well known that more than a half of diabetics are hypertensive. Therefore, it is very important to treat hypertension to reduce cardiovascular events as well as end-stage renal disease. At first, life style modification such as body weight reduction, exercise and restriction of salt and alcohol intake will be recommended. Improved glycemic control by such a non-pharmacological therapy will lower blood pressure. Recent studies demonstrated that hypoglycemic agents improving insulin resistance such as metformin and troglitazone reduce blood pressure. If these maneuvers do not lower blood pressure, hypotensive medication will be necessary. As a first line therapy, ACE inhibitor, alpha 1-blocker or Ca-channel blocker will be selected. In diabetics with proteinuria or micro-albuminuria, ACE inhibitors will be effective to delay the progression of diabetic nephropathy.