Optimal control of blood pressure in patients with diabetes reduces the incidence of macro and microvascular events.

Abstract

In patients with diabetes mellitus, hypertension is an important risk factor for cardiovascular and renal events, including macro and microvascular complications such as nephropathy. The risks are reduced when blood pressure is decreased, regardless of the treatment regimen, and intensive regimens have been found to offer greater protection than less intensive regimens. Reducing systolic blood pressure (SBP) and diastolic blood pressure to values less than 130/80 mmHg offers the most promising degree of protection, and antihypertensive therapy should be started in patients with diabetes with blood pressure greater than these values or at least in the high normal (>or= 130/85 mmHg) blood pressure range. This target lower blood pressure has typically been difficult to obtain, however, with clinical trials failing to achieve an SBP of less than 130 mmHg and blood pressure control rates in patients with diabetes only half those observed in those without diabetes. Combination antihypertensive therapy is superior to more conventional strategies, and is now considered necessary to achieve rapid blood pressure control in patients with diabetes and hypertension. Recent data have indicated that blood pressure control is more complex than previously believed. An individual's blood pressure can vary over time as a result of variations in biorhythms, methods of blood pressure measurement and central versus peripheral blood pressure; these factors therefore need to be taken into consideration when interpreting blood pressure results.