Hypertension in diabetes: Setting and achieving blood pressure goals

Aggressive treatment of hypertension - even when the condition is mild - is especially important in diabetic patients. Reasonable blood pressure targets are 130/85 mm Hg or lower in patients with type II diabetes and 120/80 mm Hg or lower in young patients with type I diabetes. In selecting therapy, consider the adverse effects of some of the antihypertensive drugs (eg, β-blockers and high-dose thiazide diuretics) as well as the beneficial effects of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers on complications of diabetes. Low-dose diuretics may be more appropriate for patients with congestive heart failure or isolated systolic hypertension; ACE inhibitors are drugs of choice for those with systolic dysfunction or microalbuminuria and nephropathy. The nondihydropyridine long- acting calcium channel blockers (eg, verapamil and diltiazem) may be best for those with angina pectoris, migraine and atrial fibrillation with rapid ventricular rate, or paroxysmal supraventricular tachycardia. Consider combination therapy if monotherapy is inadequate for control.