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Hypertension and type 2 diabetes
According to medical statistics, hypertension and type 2 diabetes frequently occur
together. The big problem is both of these conditions predispose patients to cardiovascular
and renal diseases so they put a big pressure on the patient body, developing in many
cases adverse clinical events.
In this cases, many prospective diabetes studies involving patients with both diabetes and
hypertension have shown that tight control of blood pressure (BP) is even more important
than tight control of sugar levels in reducing clinical events. The conclusion was that those
diabetics hypertensives on tighter BP control had a lower overall mortality
In this situation the choice of antihypertensive drug in the diabetic patient is very important.
Diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors,
and angiotensin-receptor blockers have all been shown to reduce adverse clinical events in
diabetic hypertensives.
Choice of drug for any patient should be individualized and it should be done according to
the presence of concomitant disease and the protection of the organ system that is most at risk
For instance:
- For diabetic hypertensives with angina pectoris, an appropriate therapy should
include a beta-blocker or calcium channel blocker given their definite antianginal and possible
antiatherosclerotic effects.
- Patients having a prior myocardial infarction need to be initiated on a beta-blocker, given its
proven benefit in preventing further cardiovascular events.
- Those diabetic hypertensives with a history of heart failure or a poor left ventricular function, should
be started on diuretics and then on an angiotensin-converting enzyme inhibitor, captopril, or
a beta-blocker, atenolol.
- If the patient has a prior stroke or transient ischemic attack, the balance of evidence calls for
therapy with a diuretic or a calcium channel blocker
- If patient needs renal protection, especially in the setting of albuminuria, an angiotensin-receptor blocker or
an angiotensin-converting enzyme inhibitor is best to prevent and delay nephropathy
NOTE: The Information on this site is provided for information only,
and is not meant to substitute for the advice of your own physician or other medical professional.
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