Step care therapy for hypertension in diabetic patients

被引:5
作者
Blackshear, JL
Schwartz, GL
机构
[1] Mayo Clin, Div Cardiovasc Dis & Internal Med, Jacksonville, FL 32224 USA
[2] Mayo Clin & Mayo Fdn, Div Hypertens & Internal Med, Rochester, MN 55905 USA
关键词
D O I
10.4065/76.12.1266
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
For diabetic patients, a goal blood pressure lower than 130/80-85 min Hg is strongly supported by clinical trial results. We review the agents, sequence, and dosing used in clinical trials and propose a treatment algorithm. Multiagent antihypertensive therapy is required to attain goal blood pressure in most patients. Step sequences to obtain this goal are suggested. In general, we favor initial therapy with an angiotensin-converting enzyme inhibitor, followed by the addition of a diuretic. The presence of comorbid conditions may dictate variation from this scheme. The effect of antihypertensive agents on established cardiovascular diseases, proteinuria, renal function, and metabolic factors is discussed. Tailored recommendations for specific clinical scenarios are described.
引用
收藏
页码:1266 / 1274
页数:9
相关论文
共 51 条
[31]   Treatment of hypertension in patients with type-2 diabetes mellitus [J].
Kjeldsen, SE ;
Os, I ;
Farsang, C ;
Mallion, JM ;
Hansson, L ;
Sleight, P .
JOURNAL OF HYPERTENSION, 2000, 18 (09) :1345-1346
[32]   Long-term comparison of losartan and enalapril on kidney function in hypertensive type 2 diabetics with early nephropathy [J].
Lacourcière, Y ;
Bélanger, A ;
Godin, C ;
Hallé, JP ;
Ross, S ;
Wright, N ;
Marion, J .
KIDNEY INTERNATIONAL, 2000, 58 (02) :762-769
[33]  
LAGER I, 1979, LANCET, V1, P458
[34]   LONG-TERM EFFECTS OF INDAPAMIDE - FINAL RESULTS OF A 2-YEAR ITALIAN MULTICENTER STUDY IN SYSTEMIC HYPERTENSION [J].
LEONETTI, G ;
RAPPELLI, A ;
SALVETTI, A ;
SCAPELLATO, L .
AMERICAN JOURNAL OF CARDIOLOGY, 1990, 65 (17) :H67-H71
[35]  
Leslie RDG, 1999, DIABETES-METAB RES, V15, P65, DOI 10.1002/(SICI)1520-7560(199901/02)15:1<65::AID-DMRR3>3.0.CO
[36]  
2-X
[37]   THE EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITION ON DIABETIC NEPHROPATHY [J].
LEWIS, EJ ;
HUNSICKER, LG ;
BAIN, RP ;
ROHDE, RD .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (20) :1456-1462
[38]   Mortality prediction in diabetic patients with myocardial infarction: Experiences from the DIGAMI study [J].
Malmberg, K ;
Ryden, L ;
Hamsten, A ;
Herlitz, J ;
Waldenstrom, A ;
Wedel, H .
CARDIOVASCULAR RESEARCH, 1997, 34 (01) :248-253
[39]  
Pitt B, 1996, AM J CARDIOL, V78, P902
[40]   The effect of spironolactone on morbidity and mortality in patients with severe heart failure [J].
Pitt, B ;
Zannad, F ;
Remme, WJ ;
Cody, R ;
Castaigne, A ;
Perez, A ;
Palensky, J ;
Wittes, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (10) :709-717