American Journal of Cardiovascular Drugs

, Volume 9, Issue 3, pp 149–162 | Cite as

A Guide to the Management of Blood Pressure in the Diabetic Hypertensive Patient

  • Nicolas W. ShammasEmail author
  • Domenic A. Sica
  • Peter P. Toth
Therapy in Practice


Diabetes mellitus and hypertension frequently coexist in patients with the insulin resistance syndrome (IRS). Patients with both diabetes and hypertension typically have widespread endothelial dysfunction, increased oxidative stress, an activated sympathoadrenal system, and an elevated systemic burden of inflammatory mediators. Patients with diabetes and hypertension also have concomitant mixed dyslipidemia and obesity with significant frequency, and are at high risk for the development of macro- and microvascular disease, congestive heart failure, and nephropathy. Current data suggest that ACE inhibitors or angiotensin receptor blockers with or without a diuretic are important, if not preferred, initial therapies for the patient with diabetes and hypertension. Other drug classes such as combined α-/β-adrenoceptor antagonists, dihydropyridine calcium channel antagonists (CCAs), and peripheral α-adrenoceptor antagonists are also useful therapeutic options in these patients. In order to optimally reduce the risk for cardiovascular events in the patient with diabetes and hypertension, optimal BP control should be coupled with comprehensive lifestyle modification and aggressive management of dyslipidemia and hyperglycemia.


Diabetic Nephropathy Amlodipine Carvedilol Angiotensin Receptor Blocker Irbesartan 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Nicolas W. Shammas has received honoraria and educational grants (via the Midwest Cardiovascular Research Foundation) from Astra Zeneca, GlaxoSmithKline, Wyeth, Merck, and Schering-Plough. Dr Shammas has no stocks, investments or patent pending with these corporations. Domenic A. Sica has received consultancies and honoraria form Novartis, Boehringer-Ingelheim, and GlaxoSmithKline. Dr Sica has received grants from Novartis. Peter P. Toth has received honoraria and grants from Merck, and Novartis. Dr Toth has received consultancies from Merck. No funding was used to prepare this review.


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Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Nicolas W. Shammas
    • 1
    Email author
  • Domenic A. Sica
    • 2
  • Peter P. Toth
    • 1
    • 3
    • 4
  1. 1.Midwest Cardiovascular Research FoundationCardiovascular Medicine, PCDavenport
  2. 2.Division of Nephrology, Department of MedicineVirginia Commonwealth University Medical CenterRichmondUSA
  3. 3.Sterling Rock Falls Clinic SterlingUSA
  4. 4.University of Illinois College of MedicinePeoriaUSA

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