Hypertension in diabetes

Hypertension appears to be critically important in diabetes mellitus, not only because of its increased prevalence, but because it accelerates both macrovascular and microvascular complications of diabetes. The evidence from which current guidelines for hypertension management are derived are the recent prospective antihypertensive outcome trials which have shown significant reductions in cardiovascular endpoints, specifically in patients with diabetes. Current recommendations for the methods of blood pressure (BP) measurement have also been upon the methods used in these trials. In addition to maximal diabetic control, management of other cardiovascular risk factors, non‐drug treatments of weight loss for obesity‐related hypertension and dietary salt reduction confer benefit. Tailored therapy for the individual patient should include: the use of non‐thiazide/beta‐blocker regimens, optimal BP targets which are lower than for the individual without diabetes, adjunctive treatments (e.g. aspirin) and the need for combination drug therapies.