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- Title
Treatment of diabetic hypertension.
- Authors
Bell, David S. H.
- Abstract
Insulin resistance and hyperglycaemia combine to make hypertension more prevalent in the type 2 diabetic patient. Blood pressure goals below those for the non-diabetic subject have been shown to be more effective in lowering mortality and cardiovascular events in the diabetic patient. To achieve these goals in most cases, three to five antihypertensives from different therapeutic groups need to be utilized. Suppression of the renin–angiotensin system (RAS) with angiotensin-converting enzyme inhibitors, angiotensin 2 receptor blockers or a renin inhibitor should be the primary therapy. A second goal should be suppression of the sympathetic nervous system utilizing a beta-blocker that does not increase insulin resistance. The addition of a diuretic, calcium channel blocker or a vasodilator to suppressors of the RAS and sympathetic nervous system aid in achieving hypertensive goals in the diabetic patient. Achieving hypertensive goals with suppression of the RAS and sympathetic nervous system should result in a decrease in mortality and cardiovascular events in the diabetic hypertensive patient. In this review article, the benefits and disadvantages of the different antihypertensive therapies in the diabetic patient are discussed.
- Subjects
HYPERTENSION; THERAPEUTICS; TYPE 2 diabetes; CARDIOVASCULAR diseases; RENIN-angiotensin system; ANGIOTENSIN converting enzyme; INSULIN resistance; HYPERGLYCEMIA
- Publication
Diabetes, Obesity & Metabolism, 2009, Vol 11, Issue 5, p433
- ISSN
1462-8902
- Publication type
Article
- DOI
10.1111/j.1463-1326.2008.00983.x