General considerations in selecting antihypertensive agents in patients with type II diabetes mellitus and hypertension.
The Working Group on Hypertension in Diabetes recommends starting pharmacologic treatment of hypertension with a small dose of a thiazide, beta-blocker, prazosin hydrochloride, angiotensin-converting enzyme inhibitor, or calcium channel blocker. Thus, these alternatives are regarded as first-line treatment in hypertensive patients with diabetes mellitus. Both thiazides and beta-blockers can cause deterioration in glycemic control and have an unfavorable influence on the lipoprotein profile. These metabolic side effects may partly counteract beneficial effects. Non-selective beta-blockers should probably be avoided in diabetic patients, since blockade of the beta-2 receptor may be associated with a compromise in peripheral blood flow and with problems associated with hypoglycemia. Cardioselective beta-blockers, which may have primary preventive effects on coronary disease, are beneficial in this patient group. In patients with non-insulin-dependent diabetes mellitus without nephropathy or overt fluid retention, diuretic therapy could be replaced by sodium restriction and/or calcium channel blocker therapy, since these agents also have a mild diuretic effect. Calcium channel blockers, angiotensin-converting enzyme inhibitors, and prazosin hydrochloride have minimal metabolic side effects, making them suitable for treatment of hypertension in this patient group.
Andrén
L
L
Department of Medicine, Ostra Hospital, University of Göteborg, Sweden.
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy
D000959:Antihypertensive Agents