Treatment of hypertension in diabetes mellitus with or without nephropathy

The link between hypertension and diabetes mellitus has been reinforced during the past year. An increasing body of evidence suggests that the treatment of hypertension retards or prevents the appearance of overt diabetic nephropathy. These data suggest that the goal blood pressure level should be lower in diabetic than in nondiabetic individuals and that nonpharmacologic interventions are particularly indicated in both type I and type II diabetes. Indeed, good metabolic control facilitates the prevention of diabetic nephropathy and allows easier control of blood pressure levels. This review discusses the recent advances in therapeutic strategies for the treatment of hypertension in patients with insulin-dependent and non-insulin dependent diabetes mellitus. Data are presented separately for each stage of diabetic nephropathy, and the importance of microalbuminuria as a marker of incipient nephropathy is assessed. Finally, pharmacologic strategies are discussed separately for type I and type II diabetes.