Diabetic hypertensive patients: improving their prognosis.
Diabetes is a devastating disease with multiple adverse effects on the vasculature. Moreover, hypertension is a prerequisite for patients with diabetes to progress to end-stage renal disease and to develop cardiovascular complications. Adequate control of blood glucose and blood pressure are the two most important factors that predict a favorable renal outcome. Recent studies have also shown that some classes of antihypertensive medications, such as the angiotensin-converting enzyme (ACE) inhibitors, may be ideal initial agents to control blood pressure in the hypertensive diabetic patient and thus to preserve renal function. In addition, nondihydropyridine calcium-channel blockers have been shown to retard the decline in renal function in patients with non-insulin-dependent diabetes mellitus (NIDDM) nephropathy who have lost at least 50% of their renal function. Retrospective analyses demonstrate that a reduction in blood pressure, especially to levels of <130/85 mg Hg in diabetic patients, retards the progression of renal disease. Reduction in arterial pressure to these low levels is probably more important than the agents used to achieve this goal. Because many of these patients require more than one medication to achieve these lower levels of arterial pressure, it is clear that fixed-dose combinations of such agents will both improve the likelihood of achieving a given blood pressure goal as well as medication compliance.
Makrilakis
K
K
Rush University Hypertension Center, Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Bakris
G
G
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D048909:Diabetes Complications; D003928:Diabetic Nephropathies / Q000517:prevention & control; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis
D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers