[Treatment of hypertension in type 2 diabetes: importance of therapeutic selection].
BACKGROUND
Type 2 diabetes and essential hypertension are the most common causes of end-stage renal disease in Argentina. Over 887 organ transplantations performed in the year 2004, 577 were kidney transplants. In urban and rural populations hypertension was more prevalent in type 2 diabetics, in particular systolic hypertension. Outcome studies are used to measure clinically meaningful primary end points, such as mortality and cardiovascular morbidity. Our current knowledge of the effects of antihypertensive agents on cardiovascular risk in hypertensive patients with type 2 diabetes has been achieved from subgroups included in large-scale studies.


METHODS
The present study, based on a search of MEDLINE literature in the period 1990-2005, revised major randomised studies with the purpose of finding out which are the most advisable therapeutic strategies against this morbid association. The majority of patients require 2 to 4 antihypertensive medications to achive BP levels that correlate with diminished progression of target organ damages. Despite the advantages of renin-angiotensin system inhibitors the initial choice of medications should be based on the evidences of target organ damages. In those patients without any evidence of complications, the primary goal seems to be achieving their BP to < 130/80 mm Hg beyond the differences among antihypertensive drugs classes, while in those with target organ damage evidences maintain BP < 120/75 mm Hg.
Feldstein
Carlos A
CA
Programa Hipertensión Arterial, Hospital de Clínicas José de San Martin, Facultad de Medicina, Universidad de Buenos Aires.
Olivieri
Antonio O
AO
Manglano
Ximena
X
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000959:Antihypertensive Agents