Diabetes and hypertension causes various micro- and macrovascular complications leading to changes in blood pressure (BP). A BP of < 130/80 mm Hg has been the recommendation for patients with both diabetes and hypertension.
However the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure-lowering trial and results from the International Verapamil SR-Trandolapril Study (INVEST) study have questioned this. The new recommendations suggest that different antihypertensive combinations may offer specific cardio-, vasculo-, and renoprotective advantages that not only treat the hypertension but also prevent complications of high BP.
Angiotensin converting enzyme (ACE) inhibitor plus diuretic combination therapy improves BP, counterbalances renin-angiotensin system activation due to diuretic therapy and reduces the risk of electrolyte alterations.
ACE inhibitor plus calcium channel blocker reduces proteinuria, the rate of decline in glomerular filtration rate (GUARD trial). Moreover, the ACCOMPLISH trial results led to the conclusion that ACE inhibitor/calcium channel blocker combo helps cardiovascular outcomes in high-risk patients.
References:
Curr Atheroscler Rep.Optimal Therapy in Hypertensive Subjects with Diabetes Mellitus.Reboldi G, Gentile G, Angeli F, Verdecchia P.
Vasc Health Risk Manag. Choice of ACE inhibitor combinations in hypertensive patients with type 2 diabetes: update after recent clinical trials. Reboldi G, Gentile G, Angeli F, Verdecchia P.
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