Chapter 12. Antihypertensive Therapy to Prevent the Cardiovascular Complications of Diabetes Mellitus

  1. William H. Herman2,
  2. Ann Louise Kinmonth3,
  3. Nicholas J. Wareham4 and
  4. Rhys Williams5
  1. Tonya L. Corbin and
  2. Alan B. Weder

Published Online: 12 JAN 2010

DOI: 10.1002/9780470682807.ch12

The Evidence Base for Diabetes Care, Second Edition

The Evidence Base for Diabetes Care, Second Edition

How to Cite

Corbin, T. L. and Weder, A. B. (2010) Antihypertensive Therapy to Prevent the Cardiovascular Complications of Diabetes Mellitus, in The Evidence Base for Diabetes Care, Second Edition (eds W. H. Herman, A. L. Kinmonth, N. J. Wareham and R. Williams), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470682807.ch12

Editor Information

  1. 2

    Department of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA

  2. 3

    General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

  3. 4

    MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK

  4. 5

    School of Medicine, Swansea University, Swansea, UK

Author Information

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

Publication History

  1. Published Online: 12 JAN 2010
  2. Published Print: 19 FEB 2010

ISBN Information

Print ISBN: 9780470032749

Online ISBN: 9780470682807

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Keywords:

  • antihypertensive therapy;
  • cardiovascular complications;
  • diabetes mellitus;
  • blood pressure control;
  • angiotensin-converting enzyme inhibitors

Summary

Hypertension develops in the great majority of patients with type 2 diabetes mellitus and dramatically increases risk for the development of the atherosclerotic cardiovascular diseases from which most patients with diabetes ultimately die. There is now complete consensus that lowering blood pressure is effective in the primary prevention of cardiovascular diseases in hypertensive patients with dibaetes, and current recommendations include blood pressure control targets below those advised for the general hypertensive population. Although tight control of blood pressure is by far the most important consideration in antihypertensive therapy, certain drug mechanisms may offer additional benefits beyond blood pressure lowering: angiotensin-converting enzyme inhibitors and or angiotensin receptor blockers are currently recommended as part of all antihypertensive regimens. The importance of differences between the various antihypertensive drug classes in the incidence of new onset diabetes is currently controversial, and we do not have outcome trials with sufficiently long follow-up to address the issue. Finally, despite compelling evidence of the benefit of antihypertensive therapy, we do a poor job as clinicians in controlling blood pressure to recommended targets. Future efforts must address the causes of poor blood pressure control and develop better ways to address the problem