Approach to arterial hypertension in patients with diabetes mellitus

In diabetic patients, the presence of hypertension amplifies an increased risk in cardiovascular disease. Approximately two- thirds of them die from cardiovascular complications. Over the last decade extensive randomised trials showing a clinically significant benefit in outcomes with lowering of blood pressure levels, led to the revision of the definition of hypertension in diabetic population. According to recent guidelines, a target blood pressure goal of < 130/80 mmHg is recommended. The diagnosis of hypertension should be made based on three or more separate measurements, after 5 minutes rest in the supine and standing position. A wider cuff should be used if the mid-arm circumference is greater than 33 cm. Non-invasive ambulatory blood pressure measurement (ABMP) is becoming more widely used in diabetic patients due to some advantages over the standard sphygmomanometer, particularly due to a close relation to a range of target organ damage. Pharmacological therapy needs to be individualised to fit patients' needs and combinations of drugs are often necessary to achieve target levels of blood pressure control. ACE inhibitors, ARBs, diuretics, calcium channel blockers and ß-blockers have all been documented to be effective pharmacological treatment. Because of the proven beneficial effects on progression of nephropathy, the established practice of choosing ACE inhibitor or AT antagonists as first-line agent in type 1 and type 2 diabetics is reasonable. Beta-blockers, diuretics and Ca channel-blockers should be used as second-line agents, and alpha-blockers, under specific indications.