All studies have emphasized this greater benefit. It appears that the higher the risk the greater the benefit from treatment of hypertension. The benefit is also related to the degree of hypertension control. Patients who also had good glucose control had even fewer complications. The treatment goal should begin with lifestyle changes, particularly weight reduction in Type 2 diabetes.
Weight loss can improve glucose, lipid and blood pressure control.
The presence of diabetes, a major risk factor, demands the institution of drug therapy. 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.