Two recent articles in the American Journal of Hypertension agree that more than one drug is frequently needed to reduce blood pressure in people with diabetes.

In an analysis of published articles on antihypertensive therapy in people with diabetes, researchers reported that more than 60% of diabetic hypertensive patients required more than one medication to control their blood pressure. They found that all four classes of antihypertensive medications were effective in reducing the incidence of cardiovascular events in diabetic hypertensive patients. In elderly patients with isolated systolic hypertension, calcium antagonists reduced the rate of cardiac events by 63%, stroke by 73%, and total mortality by 55%.

The second article concluded that most patients with diabetes, high blood pressure, and kidney disease require 3 to 5 medications to achieve optimal levels of systolic blood pressure -- which they define as 125 mmHg or less. Reducing systolic pressure to that degree is more likely to decrease the progression of kidney disease than when the target pressure is 140 mmHg. These researchers noted that ACE inhibitors are particularly effective in delaying the progression of kidney disease.

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Sources:

• Messerli FH, Grossman E, Goldbourt U. Antihypertensive therapy in diabetic hypertensive patients. American Journal of Hypertension 2001;14(5, SUPPL 1):S12-S16. (Abs.)
• Weir MR. Diabetes and hypertension: how low should you go and with which drugs? American Journal of Hypertension 2001;14(5, SUPPL 1):S17-S26. (Abs.)