Treatment of hypertension in patients associated with type 2 diabetes mellitus or metabolic syndrome

Recent guidelines including Japanese Society of Hypertension 2009 (JSH2009) recommend the lower target blood pressure such as < 130/80 mmHg in patients with diabetes mellitus, although the recent clinical trials such as ACCORD, INVEST or ROADMAP study raised questions about that the current target BP might be too low in some diabetic patients associated with coronary artery disease. In JSH2009, when BP is more than 130/80 mmHg, renin-angiotenisn blocker such as ACE inhibitor or ARB will be given as the first line hypotensive agent. If the target BP is not achieved, the dosage of ACE inhibitor or ARB is maximized or calcium channel antagonist or thiazide diuretic is added. In patients with metabolic syndrome, the target BP is < 140/90 mmHg. If their glucose tolerance is diabetic, the target BP is < 130/80 mmHg as mentioned above. The first line hypotensive agent is ACE inhibitor or ARB, since these agents improve insulin resistance.