Statement on Hypertension in Diabetes Mellitus

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Abstract
• Hypertension and diabetes mellitus are commonly associated diseases occurring in more than 2.5 million Americans, particularly in the socioeconomically disadvantaged. Hypertension contributes substantially to morbidity and mortality in the diabetic population. This article was prepared as a practical guide for the management of hypertension in diabetic persons. While treatment of hypertension in most diabetic persons does not differ from that in nondiabetic persons, this article outlines some special considerations relevant to the presence of both diseases. For both hypertension and diabetes mellitus, basic nonpharmacologic therapy consists of dietary alterations, exercise, weight management, smoking cessation, and restricted alcohol intake. These measures should be instituted as initial therapy or concomitant with pharmacologic measures. The stepped-care approach to drug treatment in essential hypertension serves as a guide to therapy. Flexibility in the use of antihypertensive drug therapy is suggested, and selected practical issues in drug treatment are reviewed. (Arch Intern Med 1987;147:830-842)