Key result
A stepped approach to antihypertensive therapy using ACE inhibitors and calcium channel blockers is proposed for diabetic patients to avoid exacerbating complications and potentially slow nephropathy.
Why the study?
What is the optimal stepped approach to antihypertensive therapy in diabetic patients?
What is the optimal stepped approach to antihypertensive therapy in diabetic patients?
ACE inhibitors and calcium channel blockers are recommended as preferred first-line antihypertensive agents in diabetic patients to avoid exacerbating diabetic complications and potentially slow nephropathy.
May support ACE inhibitor/CCB stepped therapy in diabetic hypertension; hypothesis-generating, needs randomized confirmation before practice change.
Hypertension occurs with twice the frequency in the diabetic population as compared with the general nondiabetic population. Treatment of hypertension in diabetics can be complicated by diabetic complications and the potential for adverse effects from selected antihypertensive drugs. A rational approach to antihypertensive therapy in diabetics with or without concurrent diabetic complications incorporates a "stepped" approach to therapy that includes alternative step 1 agents (eg, angiotensin-converting enzyme inhibitors and calcium channel blockers) rather than traditional agents (eg, diuretics and beta-blockers). Evolving evidence with angiotensin-converting enzyme inhibitors reveals that they do not exacerbate complications of diabetes mellitus and also may arrest or slow the progression of diabetic nephropathy. Treatment algorithms for a stepped approach to the management of the hypertensive diabetic patient are proposed.
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A R Christlieb (1990) conducted a review in Hypertension in diabetic patients. Stepped approach to antihypertensive therapy (ACE inhibitors and calcium channel blockers) vs. Traditional agents (diuretics and beta-blockers) was evaluated. A stepped approach to antihypertensive therapy using ACE inhibitors and calcium channel blockers is proposed for diabetic patients to avoid exacerbating complications and potentially slow nephropathy.
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