title: Case study: the link between hypertension and diabetes.
abstract: BACKGROUND
  Many diabetics develop hypertension, and it is a major risk factor for cardiovascular and microvascular complications.
  
  
  OBJECTIVE
  To review a case study of a patient with poorly controlled hypertension and diabetes.
  
  
  CONCLUSIONS
  Further assessment of this case study shows that the patient has poorly controlled hypertension, despite multiple medications. The patient also has metabolic syndrome complicated.by diabetes, microalbuminuria and peripheral arterial disease. The patient's hypertensive treatment options must be evaluated in light of the fact that polypharmacy has made it more difficult for her to achieve glycemic control. A panoply of drugs and drug classes are available from which to choose: diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone antagonists. New vasodilatory betablockers reduce adverse drug reactions and produce beneficial effects on arterial vasculature. Various beta~blockers' effects on insulin sensitivity are compared.
  
  
  CONCLUSIONS
  Older beta-blockers have been shown to have detrimental effects on glucose or lipid parameters. Newer agents such as nebivolol do not impact lipid, glucose, insulin, or high-density lipoproteins. Instead, nebivolol stimulates endothelial nitric oxide release in renal arteries and improves renal function.
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Gonzalez
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001578:Benzopyrans / Q000627:therapeutic use; D000075202:Contraindications; D003920:Diabetes Mellitus; D004983:Ethanolamines / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D000068577:Nebivolol; D017063:Outcome Assessment, Health Care; D019338:Polypharmacy; D012648:Self Care; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D001578:Benzopyrans; D004983:Ethanolamines; D000068577:Nebivolol