Diabetes and hypertension

Hypertension is defined as blood pressure 140/90 mm Hg or more. All patients with diabetes should have their blood pressure measured at least annually. Target blood pressure is less than 130/80 mm Hg (lower targets may be appropriate in patients with established renal disease). Angiotensin-converting enzyme inhibitors are the first-line option in most patients. Thiazides may be a reasonable choice in the elderly. Most patients require combination therapy. A, A+D, A+D+C is an appropriate stepwise protocol. Unless there are compelling indications, beta-blocker therapy should be used after other antihypertensive classes. Aspirin and statin therapy should be considered in all patients over 40 years of age.