title: Treating hypertension in type 2 diabetes.
abstract: BACKGROUND
  The co-existence of hypertension and diabetes mellitus is very common. Hypertension remarkably increases the cardiovascular risk in diabetic patients. Lowering blood pressure (BP) in these patients is particularly beneficial.
  
  
  METHODS
  This paper will discuss what the target BP is for diabetic patients and how that target can be reached.
  
  
  CONCLUSIONS
  Previous guidelines recommended lowering BP < 130/80 mmHg in diabetic patients. However, recent studies did not support this target and accordingly most recent guidelines recommend lowering BP to < 140/90 mmHg in diabetic patients. Non-pharmacological approaches are recommended in all patients. If BP levels are above the target despite non-pharmacological treatment, drug therapy should be initiated. Despite the lack of clear evidence, blockers of the renin-angiotensin-aldosterone system (RAAS) represent the cornerstone of the antihypertensive arsenal; however, in most patients combination therapy is required. Combination of RAAS blocker and a calcium antagonist is the preferred one. In many patients three or four drugs are needed. Treatment should be individualized according to concomitant risk factors and diseases and according hemodynamic and laboratory parameters as well as age. In order to maximally reduce cardiorenal risk, lipid and glycemic control should also be achieved.
authors.affiliation: Chaim Sheba Medical Center, Department of Internal Medicine D and Hypertension Unit , Tel-Hashomer , Israel +972 3 5302834 ; +972 3 5302835 ; grosse@post.tau.ac.il.
authors.forename: Yoni
authors.initials: Y
authors.lastname: Grossman
authors.forename: Gadi
authors.initials: G
authors.lastname: Shlomai
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D048909:Diabetes Complications / Q000188:drug therapy* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists
keywords: blood pressure; diabetes mellitus; target; treatment