HOW TO TREAT THE DIABETIC HYPERTENSIVE INDIVIDUAL APPROPRIATELY

Association of hypertension and diabetes Diabetes mellitus and arteria l hypertension are closely related and strongly predispose an individu al to atherosclerosis and renal failure. Hypertension is twice as freq uent in diabetic individuals as it is in the general population, and o ften precedes the development of diabetic nephropathy. The prevalence of coexisting arterial hypertension and non-insulin-dependent diabetes mellitus is increasing because of ageing of the population, allowing an augmented prevalence of atherosclerosis and end-stage diabetic rena l disease. Antihypertensive treatment of diabetic patients The goal of blood pressure control in diabetic patients is to reduce death and di sability as much as possible. In addition, other reversible risk facto rs for cardiovascular disease, which are so frequently seen in hyperte nsive diabetic individuals, need to be addressed. The optimal blood pr essure level in diabetic individuals has not yet been established, but it has been suggested that it be should lower than that recommended b y current guidelines. In fact, the literature indicates that 130/85 mm Hg should be the systolic/diastolic blood pressure in hypertensive dia betic individuals. According to most guidelines the threshold for inte rvention when multiple associated risk factors coexist with hypertensi on is a blood pressure level 140/90 mmHg. In diabetic patients therapy has to be instituted early and aggressively. In this regard, angioten sin converting enzyme inhibitors alone or in association with other dr ugs seem to be the best choice for hypertensive diabetic patients. (C) 1998 Rapid Science Ltd.