Reducing cardiovascular events in high-risk patients: the challenge of managing hypertension in patients with diabetic renal disease.

Hypertension is more prevalent and more difficult to control and is associated with a higher mortality rate in patients with diabetes than in nondiabetic patients. Elevated blood pressure contributes importantly to the development of albuminuria and progression of renal damage in diabetic nephropathy. Strong evidence indicates that the presence of albuminuria and overt nephropathy in patients with type 1 and type 2 diabetes is associated with a marked increase in the rate of fatal and nonfatal cardiovascular events. Blockade of the renin-angiotensin system in patients with type 2 diabetes with or without chronic kidney disease is associated with a significant reduction in risk for cardiovascular events. Renin-angiotensin system-blocking agents should be considered first-step pharmacologic therapy for hypertension in diabetic patients, with addition of other agents, if needed, to meet the recommended blood pressure goal of <130/80 mm Hg. In most instances, a diuretic is also needed to reduce blood pressure.