Treating high blood pressure in diabetes: the evidence.
Increases in blood pressure, even at modest levels, are associated with an increased risk of complications in diabetes. Trials have shown that treatment with blood pressure-lowering agents in type 2 diabetes lowers the risk of complications of cardiovascular and microvascular complications. ACE inhibitors appear superior in patients with microalbuminuria, although the choice of other agents is less clear, making blood pressure control itself more important than the particular agent used. The probability that a patient will require multiple therapies is increased in patients with diabetes, in part because of the increased likelihood of concurrent cardiovascular illness for which antihypertensives may have benefit. Finally, some drugs used to lower blood pressure have a benefit in individuals not considered hypertensive and appear to have a mechanism of action independent of blood pressure lowering.