Treatment of hypertension in diabetes

Abstract

The goal of the treatment of hypertension in diabetes should include values of blood pressure below 130/80 mm Hg, protection of vital life organs, decrease of cardio-vascular events and lowering general mortality. Treatment of hypertension in diabetes is very complex. Non-pharmacological treatment includes following diabetic diet and exercise regime. Pharmacological treatment includes angiotensin I converting enzyme inhibitors (ACE-I), diuretics, β-blockers, and calcium channel blockers. Other agents used in hypertension treatment are angiotensin II receptor blockers (AT1), α-blockers, imidazol receptor agonists. ACE-I inhibitors are considered first-choice drugs in the therapy of hypertension in the patients with diabetes. It has been proved that they exhibit nefro- and cardioprotective properties. The use of ACE-I inhibitors decreases the risk of complications and death due to cardiovascular system complications. The agents, which should be recommended as second-line, are diuretics and β-blockers depending on concomitant diseases. The indications for the application of β-blockers include ischaemic heart disease, the history of myocardial infarction and congestive heart failure. Calcium channel blockers have no effect on lipid disturbances and do not impair glucose tolerance. Non-dihydropirydyne calcium antagonists decrease proteinuria. Alpha-blockers are not recommended in monotherapy for the patients with diabetes. AT1 receptor antagonists are to be considered in case of ACE-I inhibitors intolerance. Recently there have been no long-term studies available for the assessment of imidazol — receptor agonists. Up till now no observations have proved their influence on carbohydrates metabolism and lipid profile. In the patients with diabetes an individual treatment of hypertension is important which should be also chosen depending on co-existing diseases. Combined treatment using small doses of hypotensive agents is usually effective.