Hypertension and the Older Diabetic

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Hypertension is a common comorbidity in persons with diabetes mellitus, and its prevalence increases with advancing age. Both diabetes mellitus and hypertension are independent risk factors for development in older persons of coronary artery disease, ischemic stroke, peripheral arterial disease, and of congestive heart failure. This article reviews studies addressing the implications of hypertension and the older diabetic.

Section snippets

Treatment of elderly diabetics with hypertension

Because elderly diabetics with hypertension are at a very high risk for developing fatal and nonfatal coronary heart disease, fatal stroke and nonfatal stroke or transient cerebral ischemic attack, peripheral arterial disease, congestive heart failure, nephropathy, left ventricular hypertrophy, and other target organ damage, these patients should have intensive treatment of modifiable risk factors. Cigarette smoking must be stopped, with a smoking cessation program instituted if necessary (Box 1

Antihypertensive studies in diabetics

Patients with diabetes mellitus or with chronic renal insufficiency, which may be present in diabetics, should have their blood pressure reduced to less than 130/80 mm Hg [37], [38], [54], [62]. Often, multiple antihypertensive drugs will be required to meet this goal [38], [54], [63], [64], [65].

In the United Kingdom Prospective Diabetes Study, 1,148 diabetics with hypertension and a mean age 56 years, were randomized to treatment with atenolol or captopril (see Box 2) [47]. At the 8.4-year

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