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Optimal Therapy in Hypertensive Subjects with Diabetes Mellitus

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Abstract

Diabetes and its micro- and macrovascular complications represent a worldwide epidemic that will place an enormous financial burden on poorer countries in the years to come. In patients with diabetes and hypertension, the main determinant of the cardiovascular and renal benefits of antihypertensive drugs is the blood pressure (BP) level achieved under treatment. Quite recently, the paradigm of a BP target < 130/80 mm Hg in these patients has been questioned by a number of trials, including data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure–lowering arm and from the diabetic cohort of International Verapamil SR-Trandolapril Study (INVEST). At the same time, even if the key role of BP control is unquestionable, a growing number of published trials suggest that different antihypertensive combinations may offer specific cardio-, vasculo-, and renoprotective advantages that go beyond BP reduction per se. The present review focuses on the most recent and important literature that explored the “optimal” antihypertensive therapy in patients with type 2 diabetes and concomitant hypertension, and it discusses in detail the various areas of uncertainty, including the specific renoprotective effects of renin-angiotensin system blocking agents and the long-term effects of angiotensin-converting enzyme/angiotensin receptor blocker combinations on the progression of diabetic nephropathy.

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Disclosure

Gianpaolo Reboldi has received honoraria from Wolters Kluwer Health Italy, Sanofi-Aventis, and NovoNordisk. He has received payment for the development of educational presentations and/or speaking fees from Wolters Kluwer Health Italy, Sanofi-Aventis, NovoNordisk, and Boehringer-Ingelheim. He has had travel and/or accommodations expenses paid for by Sanofi-Aventis, NovoNordisk, Pfizer, and Boehringer-Ingelheim.

Giorgio Gentile has received payment for the development of educational presentations and/or speaking fees from Boehringer-Ingelheim.

Paolo Verdecchia has received honoraria from Sanofi-Aventis, Novartis, and Boehringer-Ingelheim. He has received payment for the development of educational presentations and/or speaking fees from Sanofi-Aventis, Novartis, and Boehringer-Ingelheim.

Fabio Angeli reports no potential conflict of interest relevant to this article.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Perugia, Via E. Dal Pozzo, 06126, Perugia, Italy

    Gianpaolo Reboldi & Giorgio Gentile

  2. Division of Cardiology, Hospital S Maria della Misericordia, Piazzale G. Menghini, 06132, Perugia, Italy

    Fabio Angeli

  3. Division of Internal Medicine, Hospital of Assisi, Via Valentin Müller, 1, 06132, Assisi, Italy

    Paolo Verdecchia

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  1. Gianpaolo Reboldi
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  2. Giorgio Gentile
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  3. Fabio Angeli
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  4. Paolo Verdecchia
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Correspondence to Gianpaolo Reboldi.

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Reboldi, G., Gentile, G., Angeli, F. et al. Optimal Therapy in Hypertensive Subjects with Diabetes Mellitus. Curr Atheroscler Rep 13, 176–185 (2011). https://doi.org/10.1007/s11883-011-0160-9

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  • DOI: https://doi.org/10.1007/s11883-011-0160-9

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