The Management of Hypertension in Diabetic Patients

Hypertension is a critical risk factor in the development of macrovascular and microvascular complications in diabetic patients. The task of controlling blood pressure is challenged with recommendations for lower blood pressure goals, and the need for long-term use of a regimen of two or more antihypertensive agents. Moreover, there is still some controversy regarding the optimal antihypertensive agents to use in patients with diabetes.

Treatment of hypertension in diabetes generally involves using drugs that inhibit the renin-aldosterone-angiotensin system (RAAS) and the sympathetic nervous system. Several large randomized controlled clinical trials have shown reductions in clinical events with the use of ACE inhibitors or angiotensin receptor blockers (ARBs) for managing hypertension in patients with diabetes. Importantly, treatments for hypertension must be monitored for their potentially adverse effects on glycemic and lipid control. In general, thiazide diuretics and beta-blockers have been thought to decrease insulin sensitivity and increase blood glucose and lipid levels, while ACE inhibitors and angiotensin receptor blockers have been thought to have beneficial effects without affecting blood glucose levels. Newer classes of agents and new agents within established classes may not fit these conventional patterns.

In this conversation, two endocrinologists, Dr. Joseph Torre and Dr. Addison Taylor, join Dr. Carlos Hamilton, Jr. to discuss current issues surrounding the management of hypertension in diabetic patients.

Related References/Reading:

1. AACE Hypertension Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of hypertension. Endocr Pract 2006;12:193-222.
2. Andros V, Egger A, Dua U. Blood pressure goal attainment according to JNC 7 guidelines and utilization of antihypertensive drug therapy in MCO patients with type 1 or type 2 diabetes. J Manag Care Pharm. 2006;12:303-9.
3. Chobanian AV, Bakris GL, Black HR, et al; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-52.
4. Ostergren J. Renin-angiotensin-system blockade in the prevention of diabetes. Diabetes Res Clin Pract. 2007;76 Suppl 1:S13-21.