Table 1 shows how the five major drug groups interact with those variables which should be especially considered when treating the hypertensive diabetic. While diuretics are sometimes required in severely hypertensive cases-particularly when fluid retention is part of the clinical picture, and beta blockers are the outstanding choice for those with active CHD- the newer agents, particularly ACE inhibitors and alpha blockers, appear, in theory, to be better agents in terms of preventing the major adverse cardiovascular events to which diabetics are so prone. These two types of agents are very effective together and the addition of a calcium antagonist is likely to control the blood pressures of the vast majority of patients. However, one or more randomized controlled trials to evaluate whether recommendations such as these are valid is desperately needed. Meanwhile, each physician is left to make his or her own best estimate as to which drug to use and at what threshold.
