Drug Treatment of Hypertension in Patients With Diabetes Mellitus

Abstract

Patients with diabetes mellitus have an increased prevalence of hypertension and its vascular consequences, including coronary and cerebrovascular disease. Drug treatment of hypertension in diabetic subjects is fraught with potential difficulties, including the altered efficacy of medications, the increased risk of side effects, and the possibility of worsening glycemic control and increasing serum lipid levels. Despite these difficulties, treatment is an important part of reducing morbidity and mortality from vascular events. Antihypertensive therapy may also have the potential to prevent or retard the development of diabetic nephropathy. In this article, we discuss the efficacy and metabolic and nonmetabolic side effects of the various classes of antihypertensive agents in patients with diabetes mellitus and suggest a stepped-care approach to the drug treatment of patients with hypertension and diabetes.

I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica

“…Apresentam a vantagem de propiciar melhora da sensibilidade insulínica 122,123 . No entanto, o estudo ALLHAT 102 , comparando um alfabloqueador, a doxazosina, com o diurético clortalidona, mostrou uma maior ocorrência de eventos cardiovasculares, especialmente a insuficiência cardíaca congestiva, no grupo que usou a doxazosina.…”

Influence of Long-term, Low-Dose, Diuretic-Based, Antihypertensive Therapy on Glucose, Lipid, Uric Acid, and Potassium Levels in Older Men and Women With Isolated Systolic Hypertension<subtitle>The Systolic Hypertension in the Elderly Program</subtitle>

“…13,16,17 Because of the changes in CVD risk factors in hypertensive patients receiving diuretic therapy, it was speculated that the beneficial effects of lowering blood pressure may be reduced or negated and suggested that diuretics be avoided as first-line antihypertensive drugs in patients with diabetes. 14 …”

Effect of an α-Adrenergic Blocker, and ACE Inhibitor and Hydrochlorothiazide on Blood Pressure and on Renal Function in Type 2 Diabetic Patients with Hypertension and Albuminuria

“…Furthermore, they have been recently associated with increased cardiovascular mortality [13]. The angiotensin-converting enzyme (ACE) inhibitors are probably the best current choice for hypertension in diabetes due to their well-established antihypertensive, antialbuminuric and renoprotective effects and their neutral or favorable metabolic effects [14, 15, 16, 17]. Very limited and controversial information is available on the renal effect of α-adrenergic antagonists [18, 19].…”