Diabetes with hypertension medical therapy

# Overview
Hypertension is a common co-morbidity associated with patients of diabetes, especially type 2 diabetes.  Co-existence of these conditions strongly predispose patients to both renal as well as cardiovascular (CV) injury.  Diabetes is the most common cause of end-stage renal disease in the United States. The 1994 Working Group Report on Hypertension and Diabetes, has recommended the original blood pressure goals of less than 130/85 mmHg to preserve renal function and reduce cardiovascular events in these groups of patients.

# Treatment
The preferred treatment of the diabetic with hypertension includes:
- ACE inhibitors which may provide benefits above and beyond control of hypertension including delaying progression of renal disease.
- Calcium channel blockers
- Low dose diuretics

# Supportive Trial Data

## Study Name: LIFE Study, 2002 
- Study design: Double blinded, randomised, parallel-group trial
- Sample size: 1195 patients with diabetes, hypertension, left ventricular hypertrophy (on electrocardiograms)
- Study drugs: Losartan or Atenolol
- Study period: 4 years
- Study results: Losartan was found to be more effective than atenolol in reducing composite endpoints like cardiovascular morbidity and all causes mortality in patients with hypertension, diabetes, and left-ventricular hypertrophy.

## Study Name: Candesartan and Lisinopril Microalbuminuria (CALM) Study, 2000 
- Study design: Double blinded,  prospective, randomised, parallel-group, multicenteric (4 countries, 37 centers) trial
- Sample size: 199 patients with diabetes & hypertension
- Study drugs: Candesartan or lisinopril
- Study period:
Placebo run in period-4 weeks
12 weeks Candesartan or lisinopril
Followed by 12 weeks' monotherapy or combination treatment
- Placebo run in period-4 weeks
- 12 weeks Candesartan or lisinopril
- Followed by 12 weeks' monotherapy or combination treatment
- Study question: Compare the effects of candesartan or lisinopril, or both, on blood pressure and urinary albumin excretion , hypertension, and type 2 diabetes.
- Study results:  Candesartan was found to be as effective as lisinopril in reducing blood pressure and microalbuminuria in hypertensive type 2 diabetics. Combination treatment (Candesartan+lisinopril) was well tolerated and more effective in reducing blood pressure compared to either drugs alone.

## Study Name: Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial, (FACET), 1998 
- Study design: Open label, randomized trial
- Sample size: 380 hypertensive diabetics patient
- Study drugs: Fosinopril (20 mg/day) or amlodipine (10 mg/day)
- Study period: 3.5 years
- Inclusion criteria- NIDDM and hypertension (SBP > 140 mmHg or DBP > 90 mmHg).
- Exclusion criteria- History of coronary heart disease or stroke, serum creatinine > 1.5 mg/dl, albuminuria > 40 micrograms/min, and use of lipid-lowering drugs, aspirin, or antihypertensive agents other than beta-blockers or diuretics.
- Study results: Fosinopril lowered the risk of the composite endpoints of acute myocardial infarction, stroke, or hospitalization due to angina more compared to amlodipine (hazards ratio = 0.49, 95% CI = 0.26-0.95). However, no significant difference in total serum cholesterol, HDL cholesterol, HbA1c, fasting serum glucose, or plasma insulin was found.

## Hypertension/ Blood Pressure Control