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HYPERTENSION DRUGS FOR DIABETICS: NO ONE THERAPY PREFERRED

Executive Summary

HYPERTENSION DRUGS FOR DIABETICS: NO ONE THERAPY PREFERRED as the initial pharmacological treatment, a consensus panel concludes in a report published in the October issue of Diabetes Care. The report notes that "all classes of antihypertensive drugs are effective in controlling blood pressure in diabetic patients," five of which are effective alone. Of these five classes of drugs, the panel "reached no consensus that any [one] was preferred as initial drug therapy." The panel developed its recommendations last May at a consensus conference sponsored by the American Diabetes Association. The five classes of drugs are: thiazide diuretics; beta blockers; angiotensin-converting enzyme (ACE) inhibitors; calcium antagonists; and alpha[1]-receptor blockers. Since "each class of drugs has potential advantages and disadvantages," the report notes that side effects and "known pharmacologic action" must be taken into consideration when determining treatment, especially in the absence of large-scale, controlled, randomized clinical trials comparing drug efficacy. Hypertension treatment trials, when assessed according to sub- groups, have indicated that beta blockers and/or diuretics can have a similar positive effect of reducing cardiovascular morbid ity and mortality in diabetic patients as they do in nondiabetic patients, the report states. However, "ACE inhibitors have been shown to be more effective than diuretics and beta blockers in slowing the progression to diabetic renal failure," the report notes. End stage renal disease is most often caused by diabetes, according to the report. Areas cited for additional research by the panel include determining differences in classes of antihypertengive drugs' effect on cardiac/renal events in diabetic patients and exploring the genetic and metabolic factors in the etiology of hypertension in diabetes. "Pharmacologic therapy should be initiated when life-style modifications are unsuccessful in controlling hypertension," the report advises. Behavioral management of mild or moderate hypertension may be safely attempted for three months, the report concludes, after which time pharmacologic treatment becomes necessary. For severe hypertension, drug therapy should begin at diagnosis.
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