ABSTRACT
In all clinical trial more than 80% of patients with diabetic nephropathy and hypertension require two or more antihypertensive medications to attain the JNC VI recommended blood pressure goal of 130/85 mmHg [3,6]. Clinical trials that randomized participants with either diabetes and Stage 2 or higher nephropathy, (GFR <80 ml/min), to two different levels of blood pressure control showed that to achieve the desired lower BP goal, an average of 3.2 different antihypertensive medications per day was required, (Figure 1). In these and other trials, it was common to add a medication whose antihypertensive action provides complementary, additive or synergistic antihypertensive effects through different mechanisms, i.e. a diuretic with a beta blocker, an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) with a diuretic or calcium antagonist [7,8].
