Combination Therapy in Hypertension with Diabetes: Preferential Consideration for CCB and ARBs
The last edition of the International Diabetes Federation (IDF) Atlas offered projections that continue to put India at the second slot in the prevalence of type 2 diabetes right up to 2045. And the numbers remain staggering —over 134 million Indians will be diabetics in the next 25 years. (1) Hypertension occurs twice as common in patients with diabetes than in comparison to patients without diabetes. (2) In the setting of such a tenacious association and its impending threatening consequences, it remains a clinician's priority to make a prudent choice to initiate management of hypertension in diabetes with appropriate initial combination therapy for optimising long term outcomes, including both - cardiovascular and renal endpoints.
Patients with both diabetes and hypertension together possess a significantly greater risk for premature microvascular and macrovascular complications. Aggressive control of blood pressure (BP) can help to decrease both, micro- and macrovascular complications. Multidrug regimens are frequently required in diabetic hypertensives. While achieving the target BP of <130/80 is the numerical objective to arrest and prevent the progression of macro- and microvascular complications in hypertension with diabetes. (1), it may be important to consider agents which improve cardiovascular and renal outcomes in these patients.