Current Hypertension Reports

, Volume 3, Issue 5, pp 387–391

Choices and goals in the treatment of the diabetic hypertensive patient

  • Emad Basta
  • George Bakris


The number of people living in the United States who have diabetes and high blood pressure is over 11 million and rising. Together, these two diseases are devastating to the whole body if not aggressively controlled. The tight recommendations put forth by the Joint National Committee VI for better control of blood pressure and control of proteinuria have helped diminish further organ failure in patients with hypertension and diabetes. Combination therapy has been found to be very effective, and one arm should be an angiotensin converting enzyme inhibitor.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Mogensen CE: Natural history of cardiovascular and renal disease in patients with type 2 diabetes: effect of therapeutic interventions and risk modification. Am J Cardiol 1998, 82:4R-8R.PubMedCrossRefGoogle Scholar
  2. 2.
    Agardh CD, Agardh E, Torffvit O: The association between retinopathy, nephropathy, cardiovascular disease and long-term metabolic control in type 1 diabetes mellitus: a 5 year followup study of 442 adult patients in routine care. Diabetes Res Clin Pract 1997, 35:113–121.PubMedCrossRefGoogle Scholar
  3. 3.
    Stephenson JM, Kenny S, Stevens LK, et al.: Proteinuria and mortality in diabetes: the WHO Multinational Study of Vascular Disease in Diabetes. Diabetes Med 1995, 12:149–155.CrossRefGoogle Scholar
  4. 4.
    Rossing P, Hougaard P, Borch-Johnsen K, Parving HH: Predictors of mortality in insulin dependent diabetes: 10 year observational follow up study. BMJ 1996, 313:779–784.PubMedGoogle Scholar
  5. 5.
    Arent J: By the numbers. The facts about diabetes. Healthplan 2000, 41:65–66.PubMedGoogle Scholar
  6. 6.
    Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998, 317:703–713. Classic paper that clearly shows that once end-organ injury is present, it is blood pressure control, not glucose control, that will reduce cardiovascular events.Google Scholar
  7. 7.
    Adler AI, Stratton IM, Neil HA, et al.: Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000, 321:412–419.PubMedCrossRefGoogle Scholar
  8. 8.
    Bakris GL, Williams M, Dworkin L, et al.: Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000, 36:646–661. This paper presents the National Kidney Foundation position paper on control of blood pressure to reduce renal disease progression and cardiovascular events.PubMedGoogle Scholar
  9. 9.
    Maschio G, Alberti D, Janin G, et al.: Effect of the angiotensinconverting- enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting- Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N Engl J Med 1996, 334:939–945.PubMedCrossRefGoogle Scholar
  10. 10.
    Ruggenenti P, Perna A, Gherardi G, et al.: Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy [see comments]. Lancet 1998, 352:1252–1256.PubMedCrossRefGoogle Scholar
  11. 11.
    Ratzmann KP, Raskovic M, Thoelke H: Significance of proteinuria and hypertension in the prognosis of type 1 diabetes. Results of a 10-year follow-up study on micro- and macrovascular disease mortality. Deutsch Med Wochensch 1989, 114:1311–1315.Google Scholar
  12. 12.
    Agarwal A, Nath KA: Effect of proteinuria on renal interstitium: effect of products of nitrogen metabolism. Am J Nephrol 1993, 13:376–384.PubMedCrossRefGoogle Scholar
  13. 13.
    Viberti G, Mogensen CE, Groop LC, Pauls JF: Effect of captopril on progression to clinical proteinuria in patients with insulin- dependent diabetes mellitus and microalbuminuria. European Microalbuminuria Captopril Study Group [see comments]. JAMA 1994, 271:275–279.PubMedCrossRefGoogle Scholar
  14. 14.
    Grimm RH Jr, Svendsen KH, Kasiske B, et al.: Proteinuria is a risk factor for mortality over 10 years of follow-up. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Kidney Int Suppl 1997, 63:S10-S14.PubMedGoogle Scholar
  15. 15.
    Abbate M, Zoja C, Corna D, et al.: In progressive nephropathies, overload of tubular cells with filtered proteins translates glomerular permeability dysfunction into cellular signals of interstitial inflammation. J Am Soc Nephrol 1998, 9:1213–1224.PubMedGoogle Scholar
  16. 16.
    Smith AC, Toto R, Bakris GL: Differential effects of calcium channel blockers on size selectivity of proteinuria in diabetic glomerulopathy. Kidney Int 1998, 54:889–896. This paper focuses on the mechanism of why CCBs are different with regard to antiproteinuric effects in diabetes.PubMedCrossRefGoogle Scholar
  17. 17.
    Hebert LA, Kusek JW, Greene T, et al.: Effects of blood pressure control on progressive renal disease in blacks and whites. Modification of Diet in Renal Disease Study Group. Hypertension 1997, 30:428–435.PubMedGoogle Scholar
  18. 18.
    The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997, 157:2413–2446. This paper summarizes guidelines for cardiovascular and renal risk reduction as of 1997.Google Scholar
  19. 19.
    1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens 1999, 17:151–183.Google Scholar
  20. 20.
    McAlister FA, Campbell NR, Zarnke K, et al.: The management of hypertension in Canada: a review of current guidelines, their shortcomings and implications for the future. Can Med Asoc J 2001, 164:517–522.Google Scholar
  21. 21.
    Koshy S, Bakris GL: Therapeutic approaches to achieve desired blood pressure goals: focus on calcium channel blockers [in process citation]. Cardiovasc Drugs Ther 2000, 14:295–301.PubMedCrossRefGoogle Scholar
  22. 22.
    Bakris GL: Maximizing cardio-renal benefits: achieve blood pressure goals. J Clin Hypertens 1999, 1:141–148.Google Scholar
  23. 23.
    Lewis JB, Berl T, Bain RP, et al.: Effect of intensive blood pressure control on the course of type 1 diabetic nephropathy. Collaborative Study Group. Am J Kidney Dis 1999, 34:809–817.PubMedGoogle Scholar
  24. 24.
    Bakris GL, Copley JB, Vicknair N, et al.: Calcium channel blockers versus other antihypertensive therapies on progression of NIDDM associated nephropathy. Kidney Int 1996, 50:1641–1650.PubMedCrossRefGoogle Scholar
  25. 25.
    Lebovitz HE, Wiegmann TB, Cnaan A, et al.: Renal protective effects of enalapril in hypertensive NIDDM: role of baseline albuminuria. Kidney Int Suppl 1994, 45:S150-S155.PubMedCrossRefGoogle Scholar
  26. 26.
    Estacio RO, Jeffers BW, Hiatt WR, et al.: The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998, 338:645–652.PubMedCrossRefGoogle Scholar
  27. 27.
    Agodoa LY, Appel L, Bakris GL, et al.: Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA 2001, 285:2719–2728.PubMedCrossRefGoogle Scholar
  28. 28.
    Hannedouche T, Landais P, Goldfarb B, et al.: Randomized controlled trial of enalapril and beta blockers in nondiabetic chronic renal failure. BMJ 1994, 309:833–837.PubMedGoogle Scholar
  29. 29.
    Bakris GL, Mangrum A, Copley JB, et al.: Effect of calcium channel or beta-blockade on the progression of diabetic nephropathy in African Americans. Hypertension 1997, 29:744–750.PubMedGoogle Scholar

Copyright information

© Current Science Inc. 2001

Authors and Affiliations

  • Emad Basta
    • 1
  • George Bakris
    • 1
  1. 1.Rush Medical CenterChicagoUSA

Personalised recommendations