Hypertension and diabetes mellitus: the critical role of evidence based decision making in patient management.
Many diabetic hypertensives are inadequately managed because of the doctor's misplaced emphasis on possible differences in efficacy and risk profile of antihypertensive drugs. These patients are at higher risk of various cardiovascular events, and evidence shows they experience greater reduction in adverse clinical outcomes as a result of tight control of blood pressure than do nondiabetic hypertensives. It is, therefore, critically important that such patients be identified and that the blood pressure is tightly treated. Several drugs often have to be used in combination in order to achieve adequate blood pressure control. Nonpharmacologic measures, such as exercise, have been shown to reduce blood pressure and to reduce the rate complications in diabetic patients. All classes of antihypertensives have been shown to be equivalent in reducing all adverse cardiovascular events in diabetic hypertensives. Although there is nothing to choose between diuretics, calcium channel blockers, beta-blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers, the choice of drug should be tailored for the individual patient. Drug selection should be based on the complication that is most likely in the given patient. Available data suggests that the lower the blood pressure the better the prognoses, with no threshold of the lower limit of the ideal value. Many professional associations advise that a target blood pressure in the diabetic hypertensive under treatment should be below 130/80 mm Hg. There is no evidence to support the avoidance of thiazide diuretics in these patients, and indeed some patients derive specific benefits from the use of these drugs. Tight control of blood pressure is the overriding priority, and this takes precedence over the theoretical debate of which drug is the best choice or concern over possible adverse reactions.
Gangaidzo
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D002986:Clinical Trials as Topic; D003657:Decision Making; D003920:Diabetes Mellitus / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000628:therapy*