Treatment of hypertension in patients with diabetes mellitus and lower limb ischemia

Czech version

Authors: M. Souček
Authors‘ workplace: II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Miroslav Souček, CSc.
Published in: Vnitř Lék 2010; 56(4): 309-312
Category: 11th National Diabetes Symposium "Diabetes and Angiology", Hradec Kralove, 5 to 6 June 2009

Overview

he impact of some types of antihypertensives on carbohydrate metabolism and their association with type 2 diabetes is well‑known. In this respect, ACE inhibitors, AT₁ blockers or I1 imidazoline agonists, known to improve insulin sensitivity, are the first line therapeutic choice. Metabolism- neutral calcium channel blockers, particularly the dihydropyridines, are the second in line of therapeutic options. On the other hand, beta‑blockers and diuretics, thiazide in particular, exert negative effect on carbohydrate metabolism. Should their use be still desirable, e. g. due to co‑ morbidities, it is advisable to select cardio‑ selective beta‑blockers or beta‑blockers with ISA activity, since the effect of these agents on carbohydrate and lipid metabolism is less significant. Diuretics should then be used only in combination therapy and in small doses; potassium‑ sparing or metabolically neutral indapamide derivatives should be selected. The benefit of cardioprotectivity, gained from the treatment with cardioselective beta‑blockers will, particularly in patients with ischemic heart disease, usually outweigh the risk of metabolic adverse effects. Combination therapy, using AT₁ blockers or ACE inhibitors in combination with calcium channel blockers or diuretics, should be utilized to its full potential in order to ensure that target values are achieved. Recently completed studies provide the evidence to support this approach. Hypertension in patients with lower limb ischemia increases the already high cardiovascular risk in these patients. Blood pressure reduction as such is more important than a specific antihypertensive.

Key words:
antihypertensive treatment – diabetes mellitus – combination therapy – cardiovascular risk – lower limb ischemia

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