Purpose. They occur together so frequently that they are officially considered to be “comorbidities” (diseases likely to be present in the same patient). One of the strongest predictors of a poor outcome in diabetes and cardiovascular disease is the degree of renal damage as measured by aberrant loss of plasma albumin into urine. Hypertension is a major risk factor for both renal disease progression and cardiovascular morbidity and mortality in patients with type 2 diabetes (Ghaderian et al., 2015). A second goal should be suppression of the sympathetic nervous system utilizing a beta-blocker that does not increase insulin resistance. In diabetes there appears to be no ‘J’-shaped relationship between blood pressure and cardiovascular events, thus removing any concern about attaining low blood pressures as long as the patient is asymptomatic. About half the diabetic population are hypertensive and, depending on the ethnic group, between 5% and 25% of people with hypertension have diabetes.
Angiotensin converting enzyme inhibitors were the most frequently prescribed drug. Opinions on the potential advantages of the metabolic profile of some of these drugs are as yet conflicting. Despite the claims of metabolic neutrality made for many antihypertensive agents there appears to be no advantage in their use in the majority of hypertensive diabetic patients, except where there exist specific contraindications to established therapies.