Editorial [Hot Topic: Current Hypertension Reviews: Hot Topics Hypertension and Diabetes: An Emphasis on the RAS (Guest Editors: Karin A.M. Jandeleit-Dahm and Terri J. Allen)]

In this “Hot Topic” issue of Current Hypertension Reports we focus on the role of blood pressure control in diabetes and novel aspects of the renin angiotensin system. This issue includes current experimental and clinical evidence and covers important “burning” issues such as, 1. what is the optimal blood pressure target in diabetes and hypertension, 2. is there superiority of inhibitors of the renin angiotensin system (RAS) over other antihypertensive agents, 3. does combination therapy have additional benefits in terms of vascular protection and 4. which novel therapeutic options are on the horizon for better treatment and prevention of vascular complications in diabetes and hypertension? There is overwhelming evidence for an increased cardiovascular risk in the setting of concomitant hypertension and diabetes. Therefore, excellent blood pressure control is particularly important in patients who also suffer from diabetes or insulin resistance. The article by R. MacIsaac et al. addresses the question as to which blood pressure target should be aimed for. Various United States and European guidelines including the American Diabetes Association (ADA) recommendations suggest BP targets < 130/80 mm Hg for patients with diabetes. There is new evidence that further blood pressure (BP) reduction may confer superior cardiovascular benefits as shown in the recently published ADVANCE study. The ADVANCE study showed that BP reduction with perindopril and indapamide in patients usually not considered hypertensive resulted in further significant cardiovascular and renal benefits. However, the ADVANCE study did not include a comparator combination group and can therefore not answer the question as to which combination medications may be superior in preventing cardiovascular (CV) events. However, as already suggested in previous studies such as in HOPE, EUROPA, LIFE and UKPDS, the results of the ADVANCE study support current BP lowering guidelines which recommend a target BP of < 130/80 mm Hg in patients with type 2 diabetes. The ongoing BP lowering arm of the ACCORD trial will also help to substantiate the evidence supporting a continuous relationship between BP levels and the development of diabetes related vascular complications. In that trial, a group of patients with systolic blood pressures of less than 120 mm Hg is being compared to a less intensively treated group where the aim is a systolic blood pressure of less than 140 mm Hg.