HYPERTENSIVE PATIENTS AND DIABETES - A HIGH-RISK POPULATION

Rising worldwide rates of diabetes mellitus heighten the need to maint ain adequate metabolic control in diabetic patients and to control for other cardiovascular risk factors, such as lipid profile disturbances , high blood pressure, and smoking habits. This is especially the case in diabetic patients who also present with hypertension, a co-morbid state that is present in at least 50% of Type 1 and Type 2 diabetic pa tients. Cardiovascular disease is present in 75% of all diabetes-relat ed deaths, and the concomitant condition of diabetes and hypertension is believed to act synergistically on elevating the risk for cardiovas cular disease. A number of trials have demonstrated a greater incidenc e of cardiovascular disease end points in diabetic hypertensive patien ts than in diabetic normotensive patients. Furthermore, hypertension i s associated not only with an increased risk for cardiovascular mortal ity but also for microvascular complications in patients with diabetes . Adequate treatment of high blood pressure is imperative in these pat ients. The effectiveness of antihypertensive treatment can be measured not only by the degree of reduction in blood pressure but also by ass essment of the effects on urinary albumin excretion rate. It is assume d that the greater the reduction in urinary albumin excretion rate, th e greater the renoprotective effect. Treatment choices should be evide nce-based, i.e., physicians should concentrate not only on the treatme nt of hypertension but also on improving glycemic control and lipid pr ofile disorders, when necessary. When viewed in this regard, angiotens in-converting enzyme inhibitors, low-dose diuretics, and in some cases beta-blockers, should be considered agents of choice in hypertensive diabetic patients.