[Guidelines for the treatment of hypertension in diabetics].
Patients with diabetes mellitus are often associated with hypertension. Hypertension increases the incidence of cardiovascular disease and accelerates the progression of diabetic nephropathy. Japanese Society of Hypertension made own guidelines for the management of hypertension(JSH2000) in 2000. Diabetics are stratified into the high risk group irrespective of their blood pressure levels. Target blood pressure is less than 130/85 mmHg. Hypotensive agents will be initiated at more than 140/90 mmHg along with glycemic control and lifestyle modification. When their blood pressure is within the high normal(130-139/85-89 mmHg), lifestyle modification as well as glycemic control will be initiated. If their blood pressure is not lowered to less than 130/85 mmHg during the next 3-6 months, hypotensive agents will be started. ACEIs, Ca-antagonists and alpha-blockers will be the first line hypotensive agents, since these hypotensive agents improve organ damages and insulin sensitivity and do not worsen lipid metabolisms. Recent guideline made by Japan Diabetes Society in 2003 lowered the target blood pressure furthermore to less than 130/80 mmHg and added angiotensin receptor blockers as one of the firstline hypotensive agents.
Katayama
Shigehiro
S
Fourth Department of Medicine, Saitama Medical School.
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000209:etiology; D002986:Clinical Trials as Topic; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000628:therapy; D003928:Diabetic Nephropathies / Q000209:etiology; D018450:Disease Progression; D019317:Evidence-Based Medicine; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008019:Life Style; D017410:Practice Guidelines as Topic
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers