Antihypertensive agents diabetic patients

Prazosin may be particularly useful when patients cannot tolerate other types of antihypertensive agents or when blood pressure is not well controlled by other drugs. Since prazosin does not significantly influence blood uric acid or glucose levels, it can be used in hypertensive patients whose condition is complicated by gout or diabetes meUitus. Prazosin treatment is associated with favorable effects on plasma lipids. Thus, it may be of particular importance in managing patients with hyperlipidemia. 

Diabetes is the most frequent cause of end-stage renal disease. Hypertension, which is common among patients with type 2 diabetes, accelerates the development and progression of renal disease. Early and tight blood pressure control in diabetic patients, preferably with antihypertensive agents that have proven reno-protective properties, is therefore essential to minimize loss of kidney function. Several controlled clinical trials have investigated and proved the beneficial effects of ARBs on type 2 diabetic nephropathy [10-14]. 

Patients with diabetes are at very high riskfor cardiovascular disease. All patients with diabetes and hypertension should be managed with either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), typically in combination with one or more other antihypertensive agents. Multiple agents frequently are needed to control BP. 

Patients with hypertension may develop damage to either the renal tissue (parenchyma) or the renal arteries. Chronic kidney disease presents initially as microalbuminuria (30-299 mg albumin in a 24-hour urine collection) that can progress to macroalbuminuria and overt kidney failure. The rate of kidney function deterioration is accelerated when both hypertension and diabetes are present. Once patients have an estimated glomerular filtration rate (GFR) of less than 60 mL/m per minute or macroalbuminuria, they have chronic kidney disease, and the risk of cardiovascular disease and progression to severe chronic kidney disease increases. Strict BP control to a goal of less than 130/80 mm Hg can slow the decline in kidney function. This strict control often requires two or more antihypertensive agents. 

Starting therapy with a combination of two drugs is now recommended in patients far from their BP goal, for patients in whom goal achievement may be difficult (i.e., those with diabetes or chronic kidney disease and African-Americans), or in patients with multiple compelling indications for different antihypertensive agents. However, combination therapy is often needed to control BP in patients already on therapy, and most patients reqnire two or more agents. ° °... 

Savoia, C, Touyz, RM, Endemann, DH, Pu, Q, Ko, EA, De Ciuceis, C, Schiffrin, EL Angiotensin receptor blocker added to previous antihypertensive agents on arteries of diabetic hypertensive patients. Hypertension 48 271-277, 2006. 

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