Diabetes combined with hypertension antihypertensive treatment

Diabetes and hypertension are endangering people's major non-communicable chronic disease, I owned nearly 200000000 of patients with hypertension and 92000000 patients with diabetes mellitus. About half of the patients with diabetes combined with hypertension, hypertensive patients approximately within 10 years there will be 40% of the patients with diabetes mellitus. Diabetic patients if combined with hypertension, blood pressure control is closely related with the chronic complications of diabetes. We have analyzed 9258 cases of diabetes, according to systolic and diastolic blood pressure levels, grouped, systolic blood pressure from 90 to 230 mm per 20 mm Hg, Hg grouping; diastolic blood pressure of 60～ 120 mm Hg, mm Hg every 10 groups. As the systolic and diastolic blood pressure, coronary heart disease, nephropathy, diabetic fundus disease prevalence is markedly increased; good control of blood pressure in hypertensive patients with the diabetic vascular complications and prevalence rate of hypertension in patients with diabetes mellitus without obvious difference. This explains adequately, the uncontrolled hypertension accelerates the exacerbation of diabetic vascular complications and development. Hypertension for the effects of diabetic complications in diabetic complications in the course of development. Especially when diabetic patients with severe ocular fundus disease, nephropathy and cardiovascular and cerebrovascular diseases, blood pressure control is particularly important, its importance is not inferior to the high blood glucose control. According to the Chinese type 2 diabetes mellitus prevention guidelines, all blood pressure≥ 140/90 mmHg in patients with diabetes mellitus should persist in or improve health way of life based on the active use of antihypertensive drugs. The current commonly used antihypertensive drugs including angiotensin converting enzyme inhibitors ( ACEI ), angiotensin receptor antagonist ( ARB ), calcium channel blockers ( CCB ), diuretics and beta receptor antagonists. Despite some antihypertensive agents may on glucose metabolism control brings adverse effect, but the author thinks, whether by any class of antihypertensive agents, make hypertension under control and that blood pressure is at or near the 130/80 mmHg is the most important. Of course, different classes of antihypertensive agents have different characteristics, some antihypertensive agents are more suitable for diabetes patients. ACEI and ARB are a drug class in treatment of diabetes combined with hypertension based drug. These two classes of drugs in blood pressure at the same time, also contributes to the improvement of glucose metabolism and reduces urinary albumin excretion, slow the progression of diabetic kidney damage in. Endothelial damage is diabetic and hypertensive vascular lesions of the pathophysiologic basis, these two classes of drugs can improve the function of vascular endothelial cells. Some patients taking ACEI a cough, especially in dry cough, cough can disappear after treatment with ARB. In recent years, a large international clinical pharmacological experiments confirmed, valsartan has reduce and delay the onset of diabetes, which further confirmed the previous report has ACEI, ARB drugs improve glucose tolerance function. CCB has antihypertensive and protection of target cell function. The last century 70 's and early 80's, have CCB after oral glucose tolerance abnormality and diabetic case report, but after so many years of clinical practice, CCB for glucose metabolism without adverse effects, and thus can be used to ACEI and ARB intolerant patients with diabetes combined with high blood pressure, used in single ACEI or ARB is not effective control of hypertension patients. This type of medication hypotensive effect is exact, can effectively reduce the rate of diabetes in patients with cardioembolic stroke events. CCB short-acting agents tend to cause fluctuations in blood pressure, currently advocates selecting effective CCB. Beta blockers have the exact hypotensive effect, however, this class of drugs on the glucose metabolism and lipid metabolic adverse effects, it is not appropriate as diabetic hypertensive patients preferred antihypertensive drugs. Beta blockers in diabetic patients complicated with hypertension adverse effects are mainly reflected in the following aspects: to increase the levels of triglycerides, reduced high-density lipoprotein cholesterol, aggravates insulin resistance and clinical manifestation of obscure hypoglycemia. To have abnormal glucose metabolism in patients with essential hypertension, should not take this class of antihypertensive drugs. For the existence of sympathetic tone is too high, too fast heartbeat, coronary heart disease and heart failure patients, can be used in the ACEI basis, with this class of drugs. For 2-3 kind of other antihypertensive agents but not satisfactory control of hypertension, can also be added with this class of antihypertensive drugs. Long-term since, with a thiazide diuretic hypotensive are not as first choice, is the main diuretic for sugar, lipid and uric acid metabolism have adverse effects. These drugs and combined application of ACEI or ARB can avoid the adverse reactions and increase antihypertensive effect. A new class of antihypertensive agents such as indinavir diuretic indapamide is no obvious influence glycolipid metabolism. Thiazides for glycolipid metabolism and dose related, such as small dose≤ 25 MGD hydrochlorothiazide for glucose metabolism effect. In the application of ACEI or ARB or CCB to control hypertension, combined with low dose hydrochlorothiazide is safe and effective. Other antihypertensive drugs such as alpha blockers, central antihypertensive drug is not commonly used in patients with diabetes complicated with hypertension. The former is more suitable to be used with prostate hypertrophy in diabetic and hypertensive patients. And hypoglycemic drug combination, in patients with diabetes mellitus and hypertension, especially the age, course of disease, there are a variety of diabetic chronic complications of diabetes mellitus patients complicated with hypertension, generally advocate using small dose of many types of antihypertensive drugs combined, this increase is not only decreasing pressure effect, but can also play complementary roles to avoid drug, single drug the side effects of large dose of. However, ACEI and ARB as basic hypotensor is global most diabetic hypertension experts recognized. For patients with diabetes mellitus and hypertension, antihypertensive or just not enough. The ideal is to cardiovascular disease risk factors for multiple integrated control, such as high blood glucose, hypertension, hyperuricemia, high urinary albumin excretion, the occurence and development of cardiovascular diseases risk factors should be effectively controlled. Chinese Medical Association of cardiovascular science branch of the " Chinese guidelines for cardiovascular prevention " emphasizes the multiple cardiovascular risk factors in comprehensive control, this is particularly important for patients with diabetes mellitus. Domestic and international expert thinks generally, in diabetic patients with hypertension should be controlled below 130/80 mm hg. With severe kidney disease or diabetes, or in the acute phase of care or cerebrovascular disease patients, blood pressure control should it differs from man to man. Diastolic blood pressure below 60 mm Hg in patients with coronary artery disease, should be in close monitoring of blood pressure in the case of gradual realization of BP control. Excessive hypotensive risk. When the pressure drops to a certain degree, prone to cardiac and cerebral infarction.