To study the preferred antihypertensive drugs in patients suffering from diabetes mellitus at a tertiary care hospital of Uttarakhand with an emphasis on compelling indications

Hitender Kumar, Megha Gupta, Shakti Bala Dutta, Amit Varma, Amandeep Singh, Mirza Atif Beg


Background: People with diabetes are more likely to also have high blood pressure. Hypertension can increase the risk of diabetes complications and is a powerful risk factor for development of a wide variety of cardiovascular, cerebrovascular and renal diseases. The treatment of hypertension in patients with diabetes thus becomes all the more important and may effectively prevent cardiovascular events. This study was thus planned with the aim to study the preferred antihypertensive drugs in patients suffering from diabetes mellitus and to teach UG students about the clinical importance of compelling indications in the treatment of hypertension.

Methods: A total of 100 prescriptions of patients suffering from hypertension and diabetes mellitus were collected from diabetic hypertensive visiting the department of Medicine. Data was analysed in terms of percentage to find out the most and least preferred antihypertensive drugs in diabetes mellitus.

Results: ACE inhibitors (30.95%) and ARBs (30.16%) were the most preferred, diuretics (19.84%), and CCBs (11.9%), and beta blockers (7.14%) were the least preferred antihypertensive drugs in diabetes patients. Three patients were on non-pharmacological treatment and among the remaining 97 prescriptions, monotherapy was the most common mode (70.1%) of therapy for hypertension, and drugs in combination were prescribed to 29.89% patients.

Conclusions: ACE-I and ARBs were the preferred antihypertensive drugs prescribed in diabetic hypertensive. Treatment of hypertension should be individualized depending upon the compelling indications. This should be taught to undergraduate students in a practical way in collaboration with Medicine department.


Hypertension, Diabetes mellitus, Antihypertensive drugs, Compelling indications

Full Text:



World Health Organization, Diabetes fact sheet N°312, 2013. Available at Assessed on 13 May 2016.

King H, Aubert RE, Herman WH. Global Burden of Diabetes, 1995-2025. Prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414-3.

American diabetes association. Treatment of hypertension in adults with diabetes. Diabetes care. 2003;26(1):S80-S82.

Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension. 1992;19:403-18.

Landsberg L, Molitch M. Diabetes and hypertension: pathogenesis, prevention and treatment. Clin Exp Hypertens. 2004;26:621-8.

Cheung BM. The hypertension-diabetes continuum. J Cardiovasc Pharmacol. 2010;55:333-9.

Cardillo C, Kilcoyne CM, Nambi S. Vasodilator response to systemic but not to local hyperinsulinemia in human forearm. Hypertension. 1998;32:740-3.

Kaplan NM. System hypertension: mechanism and diagnosis. In: Brawnwald E, Zipes DP, Libby P, Bonow RO. Braunwald's Heart Diseases: A Textbook of Cardiovascular Medicine. 7th Ed; 2005:959-987.

Rizos CV, Elisaf MS. Antihypertensive drugs and glucose metabolism. World J Cardiol. 2014;6(7):517-30.

Martin-Timon I, Sevillano-Collantes C, Segura-Galindo A, Cañizo-Gómez FJ. Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J Diabetes. 2014;5(4):444-70.

Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension. 2001;37:1053-9.

Black HR, Bakris GL, Elliot WJ. Hypertension: epidemiology, pathophysiology, diagnosis and treatment. In: Fuster V, Alexander RW, O’Rourke RA (editors). Hurst’s The Heart.11th Ed. New York: McGraw Hill Publication. 2005;2:1553-1606.

Requirements for antihypertensive therapy in diabetic patients: metabolic aspects. Teuscher AU, Weidmann PU. J Hypertens Suppl. 1997;15(2):S67-75.

UK Prospective diabetes study group: intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. National heart, lung, and blood institute national high blood pressure education program coordinating committee: seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-52.

Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. European society of hypertension. Reappraisal of European guidelines on hypertension management: a European society of hypertension task force document. J Hypertens. 2009;27(11):2121-58.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA. 2014;311(5):507-20.

Weber MA, Bakris GL, Jamerson K, Weir M, Kjeldsen SE, Devereux RB, et al. Cardiovascular events during differing hypertension therapies in patients with diabetes. J Am Coll Cardiol. 2010;56(1):77-85.

Weidmann P, Boehlen LM, de Courten M, Ferrari P. Antihypertensive therapy in diabetic patients. J Hum Hypertens. 1992;6(2):S23-36.

McAlister FA, Campbell NRC, Duong-Hua M, Chen Z, Tu K. Antihypertensive medication prescribing in 27,822 elderly canadians with diabetes over the past decade. Diabetes Care. 2006;29:836-41.

Johnson ML, Singh H. Patterns of antihypertensive therapy among patients with diabetes. Journal of general internal medicine. 2005;20:842-6.

Janagan T, Kavitha R, Sridevi SA, Veerendra V. Prescription pattern of antihypertensive drugs used in hypertensive patients with associated type 2 diabetes mellitus in a tertiary care hospital. International Journal of Pharma Research and Review. 2014;3(1):1-5.

Das AKL. A study on prescribing pattern of antihypertensive drugs in diabetic patients at a tertiary care teaching hospital. Int J Med Res Prof. 2015;1(3);118-21.

American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2013;36 suppl 1:S11-66.

Panda BB, Pati1 MR, Sahu PK. Survey of prescription pattern of antihypertensive drugs in hypertensive and diabetic hypertensive patients. Asian J Pharm Clin Res. 2015;8(1):250-2.

Singh N, Dhanaraj E, Tiwari P, Bhansali A. Attainment of target blood pressure and patterns of antihypertensive therapy in type 2 diabetic hypertensive Asian Indians. International Journal of Risk and Safety in Medicine. 2008;20(1-2):45-50.