Antihypertensive treatment in diabetics

Based on many epidemiological studies, hypertensive diabetics have been regarded as high risk for cardiovascular disease. The sixth Joint National Committee guideline (JNC VI) recommended to start hypotensive agents even at high normal blood pressure, i.e. over 130/85 mmHg and lower their blood pressure to less than 130/85 mmHg. If patients are associated with renal dysfunction (proteinuria of more than 1 g/day), the target blood pressure would be less than 125/75 mmHg. These target blood pressures were supported Hypertension Optimal Treatment study and/or UKPDS. ACE inhibitors, Ca-antagonists or alpha-blockers were regarded as one of the first line drugs. Japanese Society of Hypertension has established the guideline for hypertension treatment, in which almost the same recommendation has been made for diabetics except one point, i.e., at high normal blood pressure, lifestyle modification might be the initial treatment followed by hypotensive agents if their blood pressure dose not go down to less than 130/85 mmHg during the next 3-6 months. Based on these guidelines, more vigorous antihypertensive treatment would be recommended in diabetics to reduce micro- and macrovascular disease.