This is not easy to answer, but one principle to remember is that control of blood pressure is the critical goal and this usually requires two to three drugs. In patients with diabetic nephropathy an ACE inhibitor should be one of the drugs. In patients with angina or a recent myocardial infarction b -blockers should be used. The concern over hypoglycemia with the use of b -blockers has been grossly exaggerated. The middle-aged or older diabetic patient is assumed to have underlying coronary heart disease.
Glycemic control can also improve abnormal lipid levels, especially triglycerides.
This vigorous treatment of the hypertensive diabetic patient can yield gratifying results in lowering cardiovascular complications, but it is expensive and beyond the reach of many developing countries. The key to success is to control obesity at an early age. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. This Web service is provided by the Medical College of Ohio.