The importance of tight blood pressure control in diabetic hypertensive patients

RESUMO

There is a worldwide pandemic of type 2 diabetes mellitus (DM) that is projected to further increase in the next several decades, due in part to aging and increasing obesity. DM and hypertension are chronic conditions that very frequently coexist in older subjects and both conditions are strongly predisposing factors to the development of cardiovascular disease (CVD) and of renal damage with enormous economic and social burden to all countries. Currently, there is clear-cut evidence that the tight control of high blood pressure and associated risk factors such as hyperglycemia and dyslipidemia reduce the burden of CVD and renal disease in patients with DM. ln addition, the control of systolic blood pressure, especially in older patients, reduces the risk of stroke and other CVO events. Non-pharmacological treatment with appropriate diet and exercise program is an important component of therapy in persons with established diabetes. However, a non-pharmacological approach is often not enough to achieve desirable blood pressure values goals; in this regard pharmacological strategies that block the renin-angiotensin system (RAS) have special benefits in diabetic hypertensive patients and may prevent the development of clinical diabetes in hypertensive patients with impaired glucose tolerance. The use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor-blocking agents (ARBs), besides blood pressure control, decrease the rate of development of proteinuria and diabetic nephropathy. Therefore, an aggressive control of blood pressure to values below 130/80 has an important impact on the complications of type 2 DM