The increased prevalence of diabetes in the affluent countries has received considerable attention in recent years. Along with a greater prevalence of obesity in, diabetes, particularly diabetes in older persons, is on the rise. This is a serious public health problem because people with diabetes are at much greater risk for strokes, heart attacks, and kidney failure. These risks are magnified if hypertension is present, and thus blood pressure control is as important as blood sugar control in people with diabetes. We know that those individuals with diabetes should have their blood pressure lowered to levels that are lower than those recommended for patients with hypertension without diabetes. The "target" blood pressure for a patient with diabetes is less than 135/85 mmHg. Achieving blood pressure control is especially important in patients with diabetes who show signs of kidney damage, since lowering blood pressure has been shown to protect the kidneys from further damages. All blood pressure medications are safe in diabetic patients.
At the present time, we believe that it is not how you lower the blood pressure, but whether or not you do that is important, although this is an area that is being actively investigated. In patients with kidney disease, angiotensin converting enzyme inhibitors should be part of the treatment regiment since these drugs have a beneficial effect of kidney function.