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Treatment of the Hypertensive Diabetic: Focus on Calcium Channel Blockade

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How Should Elderly Hypertensive Patients Be Treated?

Summary

In diabetes mellitus (DM) type 1, blood pressure (BP) tends to rise in association with incipient diabetic nephropathy. In DM type 2, hypertension (HT) may develop before or during DM or nephropathy. Regardless of DM type, sodium retention and vascular hyperreactivity seem to be important factors in the pathogenesis of HT. DM and HT may concomitantly promote cardiovascular complications and the course of diabetic nephropathy and retinopathy.

Considering the high risk of early cardiovascular and renal disability or death, dietary and, if necessary, drug treatment in diabetic patients aims at normalizing metabolic risk correlates as well as BP. Thiazide diuretics are not ideal for initial antihypertensive therapy; although they may simultaneously improve BP, body sodium, and vascular hyperreactivity, they as well as loop diuretics can impair glucose tolerance further, promote hypokalemia with its arrythmogenic potential, and increase potentially atherogenic serum cholesterol and triglyceride fractions. ß1-blockers have fewer, although still some unwanted metabolic or cardiovascular side effects. Calcium channel blockers or angiotensin-converting enzyme (ACE) inhibitors may often improve hypertension without causing relevant metabolic impairment or modifying hypoglycemic symptoms. Treatment with nitrendipine in hypertensive type 2 diabetics lowered not only BP and vascular reactivity, but also serum uric acid, while carbohydrate and lipid metabolism were unchanged. Differential effects of antihypertensive drugs on the progression of human diabetic nephropathy and long-term prognosis in diabetics remain to be determined. In the meantime, calcium channel blockers offer a potentially useful alternative for first-line treatment of HT in diabetic patients.

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Authors and Affiliations

  1. Medizinische Poliklinik, University of Berne, CH-3010, Berne, Switzerland

    Paolo Ferrari

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  1. Peter Weidmann
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  2. Bernhard N. Trost
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  3. Paolo Ferrari
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Editors and Affiliations

  1. National Cardiovascular Center Hospital, Suita, Osaka, 565, Japan

    Teruo Omae (Director of Hospital) (Director of Hospital)

  2. Centro di Fisiologia Clinica e Ipertensione, Ospedale Maggiore di Milano, Instituto di Clinica Medica IV, Università di Milano, 20122, Milan, Italy

    Alberto Zanchetti (Professor) (Professor)

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Weidmann, P., Trost, B.N., Ferrari, P. (1989). Treatment of the Hypertensive Diabetic: Focus on Calcium Channel Blockade. In: Omae, T., Zanchetti, A. (eds) How Should Elderly Hypertensive Patients Be Treated?. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68340-7_6

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  • DOI: https://doi.org/10.1007/978-4-431-68340-7_6

  • Publisher Name: Springer, Tokyo

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