COMBINATION THERAPY AND TARGET ORGAN PROTECTION IN HYPERTENSION AND DIABETES-MELLITUS

Both essential hypertension and diabetes mellitus affect the same majo r target organs-the brain, the fundi, the heart, and the kidneys. The common denominator of hypertensive/diabetic target organ disease is th e vascular tree. Both hypertension and diabetes are well identified ri sk factors for atherogenesis. Coronary artery disease is much more com mon in diabetic hypertensive patients than in patients suffering from hypertension or diabetes alone. Typical for the diabetic hypertensive heart are extensive degenerative changes and a greater degree of hyper trophy compared with the nondiabetic hypertensive heart. The combined presence of hypertension and diabetes concomitantly affects glomerular filtration rate and renal blood now, thereby greatly accelerating a d ecrease in renal function. Hypertension accelerates the development of diabetic retinopathy; hypertensive/diabetic cerebral disease leads to vascular dementia, transient ischemic attacks, and strokes. A decreas e in the hemodynamic and glycemic burden is the primary goal in the ma nagement of the hypertensive diabetic patients. Both diuretics and bet a-blockers have been reported to adversely affect the overall risk fac tor profile in the diabetic patient. In contrast, the postsynaptic alp ha-blockers, the calcium antagonists, and the angiotensin-converting e nzyme inhibitors have been reported to be either neutral or beneficial with regard to the overall metabolic risk factor profile. The combina tion of a heart-rate lowering calcium antagonist, particularly verapam il, with an ACE inhibitor offers some potential to either prevent or r everse target organ disease associated with hypertension and diabetes. (C) 1997 American Journal of Hypertension, Ltd.