If you have diabetes, your risk of death increases by a factor of seven if you also have hypertension-and its estimated that more than 75 percent of diabetics have high blood pressure or are taking blood pressure medication. Given those statistics, its not surprising that new guidelines for treating hypertension in patients with diabetes have recently been issued by the American Society of Hypertension (Journal of Clinical Hypertension, October 2008). The guidelines urge a more aggressive treatment approach as well as more frequent medication monitoring. They also note that early identification and management of proteinuria-an elevated level of protein in the urine that signals the possibility of kidney disease-is an essential part of lowering heart risks for diabetics. "It is a vicious cycle-once you start developing kidney disease, your blood pressure goes up further. Its a feed-forward kind of thing," says Leann Olansky, MD, an endocrinologist at Cleveland Clinic.
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