What drugs are best to treat high blood pressure in diabetics?

January 25, 2011|By Dr. Mary Pickett

Q: I have diabetes and high blood pressure. Is the combination of lisinopril and amlodipine a good choice?

A: Your combination of drugs to treat high blood pressure is one of the best. Many experts consider this their first choice for treating high blood pressure (hypertension) in people with diabetes.

For most people with diabetes, two or more drugs are eventually needed to control blood pressure to the goal level. The top number (systolic pressure) should be less than 130 mmHg. The bottom number (diastolic pressure) should be less than 80 mmHg.

Treating high blood pressure helps to prevent complications from diabetes, including:

Heart disease

Kidney problems

Worsening vision

Several studies have helped to sort out what blood pressure drugs seem to have the best advantage for treating people with diabetes.

The first drug should be an "ACE inhibitor" (angiotensin-converting enzyme inhibitor). These protect against kidney damage in ways that go beyond lowering blood pressure. Commonly prescribed ACE inhibitors include:

lisinopril (Zestril, Prinivil)

enalapril (Vasotec)

moexipril (Univasc)

benazepril (Lotensin)

If you cough as a side effect from an ACE inhibitor, you can substitute a drug from a group known as angiotensin receptor blockers. These drugs give the same protection as ACE inhibitors do. They are more expensive, so they're used only for people who need to switch. Examples of these drugs include losartan (Cozaar) and valsartan (Diovan).

If you need a second drug, either amlodipine (Norvasc) or its close relative, felodipine (Plendil) are perhaps the best. In combination with an ACE inhibitor, these drugs seem to offer the best protection against cardiovascular disease.

Another excellent choice for a second medicine to control high blood pressure is hydrochlorothiazide or any other "thiazide" diuretic. These drugs lengthen survival and prevent complications from high blood pressure. These drugs can make it slightly harder for some people with diabetes to control their blood sugar levels, but this is a small effect.

(Mary Pickett, M.D., is an associate professor at Oregon Health & Science University where she is a primary care doctor for adults. She is a lecturer for Harvard Medical School and a senior medical editor for Harvard Health Publications.)



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