Benefits of combination angiotensin-converting enzyme inhibitor and calcium antagonist therapy for diabetic patients

Effective control of blood pressure is important in slowing renal disease p rogression in diabetic nephropathy. However, blood pressure is often diffic ult to control with monotherapy, especially in this patient population in w hom three medications are sometimes required to attain goal blood pressures of less than 130/85 mm. Further, physicians are often reluctant to increas e the dose or add another agent to an existing regimen. The advent of low-dose, fixed-dose combination therapy allows physicians th e ability to prescribe two drugs in one pill and, hence, to improve complia nce. In fact, the Sixth Report of the Joint National Committee on Preventio n, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) rec ommends adding a second antihypertensive agent as an option if goal blood p ressure is not achieved with a single agent. The combination of an angioten sin-converting enzyme (ACE) inhibitor and calcium antagonist may confer add itive antihypertensive benefit, and may even improve the side-effect profil e. This paper reviews the importance of aggressive blood pressure control i n diabetic patients and the clinical trials supporting the use of combinati on ACE inhibitor/calcium antagonist therapy in the diabetic patient populat ion. Am J Hypertens 1999;12:80S-85S (C) 1999 American Journal of Hypertensi on, Ltd.