Management of hypertension in diabetes

The prevalence of hypertension is increased approximately two-fold in the diabetic population. Hypertension elevates the risk of morbidity and mortality from macrovascular and microvascular complications of diabetes. Effective antihypertensive treatment decreases the progression of diabetic nephropathy. ACE inhibitors may have a specific renal protective effect in patients with early diabetic nephropathy. There are few, nonconclusive data concerning the effects of antihypertensives on other diabetic complications. Diuretics should be avoided in diabetic patients since their use may increase the cardiovascular mortality in this group of patients. Therapeutic approaches to patients with IDDM, NIDDM, and patients with diabetic complications are discussed.