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The non-drug treatment of hypertension in the diabetic patient.

A wide range of non-pharmacological manoeuvres have been tried for the control of BP but the majority of studies have not examined diabetic patients. Alteration of individual dietary components is difficult to achieve and results difficult to interpret. A high fibre, low fat, moderate salt restricted diet is as efficacious as drug therapy in some hypertensive diabetic patients. Similar diets have been recommended for all diabetic patients by the British Diabetic Association and the European Association for the Study of Diabetes. This diet has the added advantage of improving glycaemic control and plasma lipid profiles. The benefits of behavioral modifications are variable, with some being better than placebo. Although there is no evidence for a hypertensive effect of smoking, it should be strongly discouraged in diabetic patients because of the added cardiovascular risk it places upon them. Studies of dietary control of BP indicate that a response should be observed after three months of treatment. If blood pressure remains elevated after this time the patient should be treated with pharmacological agents. Hyperinsulinaemia may be important in the pathogenesis of Type II diabetes, coronary artery disease and essential hypertension. Dietary manoeuvres which reduce plasma insulin levels may prove to be of benefit in all of these conditions, but as yet data are not available to support this hypothesis.