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Early treatment of hypertension is particularly important in diabetic patients both to prevent cardiovascular disease and to minimize progression of renal disease and diabetic retinopathy. Among patients with type2 diabetes, the benefits of tight blood pressure control may be as great or greater than the benefit of strict glycemic control.Initial therapy should include nonpharmacologic methods, such as weight reduction, increased consumption of fresh fruits, vegetables, and low-fat dairy products, exercise, salt restriction, and avoidance of smoking and excess alcohol ingestion. This is consistent with the American Heart Association and the American Diabetes Association2007 guidelines which state that, among patients with a systolic blood pressure of130 to139 mmHg or a diastolic pressure of80 to89 mmHg, initial therapy should consist of nonpharmacologic methods. If target blood pressure is not achieved after three months, treatment with pharmacological agents should be initiated.Since hypertension places diabetic patients at high risk for cardiovascular complications, all diabetic patients with persistent blood pressures above140/90 mmHg should be started on antihypertensive drug therapy . Successful implementation of nonpharmacologic therapy may permit later reduction in the dose or number of antihypertensive agents.
Intensive drug therapy is unequivocally protective . In addition, prior observations concerning adverse effects of various antihypertensive drugs are now understood to be due in part to the administration of inappropriately high doses of diuretics and noncardioselective beta blockers.
GOAL BLOOD PRESSURE : Major guidelines have suggested that the goal blood pressure in patients with diabetes mellitus is less than130/80 mmHg.
to preserve blood vessels, kidney and heart.
