Step care therapy for hypertension in diabetic patients

For diabetic patients, a goal blood pressure lower than 130/80-85 min Hg is strongly supported by clinical trial results. We review the agents, sequen ce, and dosing used in clinical trials and propose a treatment algorithm. M ultiagent antihypertensive therapy is required to attain goal blood pressur e in most patients. Step sequences to obtain this goal are suggested. In ge neral, we favor initial therapy with an angiotensin-converting enzyme inhib itor, followed by the addition of a diuretic. The presence of comorbid cond itions may dictate variation from this scheme. The effect of antihypertensi ve agents on established cardiovascular diseases, proteinuria, renal functi on, and metabolic factors is discussed. Tailored recommendations for specif ic clinical scenarios are described.