Antihypertensive treatment in diabetes and diuretics

Blood pressure elevation occurs more commonly among diabetic patients than in non-diabetic subjects and represents one of the main reasons for their high cardiovascular risk. Sodium retention is an important pathogenic factor contributing to the genesis of hypertension in diabetes. Effective blood pressure reduction in diabetic patients, for which combination drug therapy is generally needed from the outset, confers an exceptionally high benefit with regard to vascular and renal outcomes. Thiazide diuretics are not recommended as optimal first-line treatment in hypertensive diabetic patients since they may be associated with adverse metabolic effects. However, due to their effect on sodium excretion they represent a very useful component of drug combination therapy. When used with ACE inhibitors or AT₁-blockers, thiazide diuretics may help to attain the low target levels of current treatment guidelines, especially with regard to systolic blood pressure. Adequate doses of loop diuretics are needed for the maintenance of a balanced sodium and water metabolism in advanced stages of diabetic nephropathy.

Keywords: diabetes mellitus; hypertension; diuretics