Hypertension should be treated aggressively in patients with diabetes. The goal for blood pressure is less than 130/80 in adults and below the 90th percentile for age in children. In the patient with diabetes, angiotensin-converting enzyme (ACE) inhibitors are the first choice for treatment of hypertension.
Comment: Hypertension is a significant risk factor for many of the complications of diabetes, playing a role in the development of retinopathy, nephropathy, and cardiovascular disease. Because cardiovascular disease is the most significant contributor to the morbidity and mortality in patients with type 2 diabetes, aggressive regulation of blood pressure is advised. A recent clinical advisory from the National High Blood Pressure Education program (7) indicates that the coexistence of diabetes and hypertension warrants a lower blood pressure goal (135/80) than for the patient with hypertension who does not have diabetes (140/ 90). ACE inhibitors, and perhaps angiotensin-receptor blockers, offer many advantages in the treatment of hypertension in the patient with diabetes. There is evolving research examining the role of these agents in vascular reactivity, endothelial function, and fibrinolysis that may underlie the recent exciting observation from the MICRO-HOPE study of a protective role for ACE inhibitors against cardiovascular disease in persons with diabetes (8).
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