Step care therapy for hypertension in diabetic patients

Joseph L. Blackshear, Gary L. Schwartz

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations


For diabetic patients, a goal blood pressure lower than 130/80-85 mm Hg is strongly supported by clinical trial results. We review the agents, sequence, and dosing used in clinical trials and propose a treatment algorithm. Multiagent antihypertensive therapy is required to attain goal blood pressure in most patients. Step sequences to obtain this goal are suggested. In general, we favor initial therapy with an angiotensin-converting enzyme inhibitor, followed by the addition of a diuretic. The presence of comorbid conditions may dictate variation from this scheme. The effect of antihypertensive agents on established cardiovascular diseases, proteinuria, renal function, and metabolic factors is discussed. Tailored recommendations for specific clinical scenarios are described.

Original languageEnglish (US)
Article number62803
Pages (from-to)1266-1274
Number of pages9
JournalMayo Clinic proceedings
Issue number12
StatePublished - 2001


  • ABCD = Appropriate Blood Pressure Control in Diabetes
  • ACE = angiotensin-converting enzyme
  • ARB = angiotensin receptor blocker
  • CAPP =Captopril Prevention Project
  • FACET = Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial
  • HOPE = Heart Outcomes Prevention Evaluation
  • HOT = Hypertension Optimal Treatment
  • INSIGHT = Intervention as a Goal in Hypertension Treatment
  • RALES = Randomized Aldactone Evaluation Study
  • SHEP = Systolic Hypertension in the Elderly Program
  • UKPDS = United Kingdom Prospective Diabetes Study

ASJC Scopus subject areas

  • General Medicine


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