The Rationale and Indications for Angiotensin Receptor Blockers in Heart Failure

Treatment of diabetic hypertension

Insulin resistance and hyperglycaemia combine to make hypertension more prevalent in the type 2 diabetic patient. Blood pressure goals below those for the non-diabetic subject have been shown to be more effective in lowering mortality and cardiovascular events in the diabetic patient. To achieve these goals in most cases, three to five antihypertensives from different therapeutic groups need to be utilized. Suppression of the renin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitors, angiotensin 2 receptor blockers or a renin inhibitor should be the primary therapy. A second goal should be suppression of the sympathetic nervous system utilizing a beta-blocker that does not increase insulin resistance. The addition of a diuretic, calcium channel blocker or a vasodilator to suppressors of the RAS and sympathetic nervous system aid in achieving hypertensive goals in the diabetic patient. Achieving hypertensive goals with suppression of the RAS and sympathetic nervous system should result in a decrease in mortality and cardiovascular events in the diabetic hypertensive patient. In this review article, the benefits and disadvantages of the different antihypertensive therapies in the diabetic patient are discussed.

Heart failure in the diabetic patient

This review examines the extent of the increased rate of heart failure (HF) in the diabetic patient, along with the possible causes for this increase and the poor prognosis associated with HF. Also reviewed are the therapies that are available for the treatment of diabetic HF and whether intensifying the use of these therapies might improve the worsened clinical outcomes for the patient who has diabetes.