Treatment of hypertension in type 2 diabetes.

Hypertension is one of the most common medical conditions in the United States, affecting 50 million American adults and accounting for one of four physician office visits. It is often undetected and undertreated, creating significant public health consequences. In diabetes, hypertension is an even greater problem, as diabetes has become the most common single cause of end-stage renal disease (ESRD) in the world, and diabetes is increasing in prevalence. The most important factor in slowing the decline of renal function in diabetes is aggressive treatment of hypertension. Recent guidelines have emphasized that the target blood pressure levels for patients with diabetes should be lower than in other hypertensive groups. The best specific approach for the treatment of hypertension in diabetic patients is the subject of much debate. It may be in the end that the specific drug choice has less overall importance than the actual attainment of adequate blood pressure control. In addition, more credence must be placed on the value of treating systolic hypertension than has traditionally been given. Coexisting diabetes and hypertension are a common clinical scenario that can set off a vicious cycle of increasing renal damage, rising blood pressure, and increased cardiovascular morbidity and mortality. Treatment often requires multiple drugs to effectively preserve renal function and prevent complications.