Benefits of combination angiotensin- converting enzyme inhibitor and calcium antagonist therapy for diabetic patients

Effective control of blood pressure is important in slowing renal disease progression in diabetic nephropathy. However, blood pressure is often difficult to control with monotherapy, especially in this patient population in whom three medications are sometimes required to attain goal blood pressures of less than 130/85 mm. Further, physicians are often reluctant to increase the dose or add another agent to an existing regimen. The advent of low-dose, fixed-dose combination therapy allows physicians the ability to prescribe two drugs in one pill and, hence, to improve compliance. In fact, the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) recommends adding a second antihypertensive agent as an option if goal blood pressure is not achieved with a single agent. The combination of an angiotensin-converting enzyme (ACE) inhibitor and calcium antagonist may confer additive antihypertensive benefit, and may even improve the side-effect profile. This paper reviews the importance of aggressive blood pressure control in diabetic patients and the clinical trials supporting the use of combination ACE inhibitor/calcium antagonist therapy in the diabetic patient population.