Figure.

A suggested paradigm by which blood pressure goals in people with renal insufficiency and/or diabetes can be achieved by the least intrusive means possible. Everyone with diabetes and/or renal insufficiency should be instructed on lifestyle modifications, as per the JNC VI. Everyone, however, should be started on therapy if blood pressure is greater than 130/85 mm Hg. In patients with blood pressures >15/10 mm Hg above goal, two drugs should be used; in patients with blood pressures above goal but not >15/10 mm Hg above goal, one drug may be used alone. #Note: If blood pressure is <15/10 mm Hg above goal (130/80 mm Hg), an angiotensin‐converting enzyme (ACE) inhibitor alone may be used. The ACE inhibitor should be the same if two different fixed dose combinations are used. *Non‐dihydropyridine calcium channel blockers (verapamil and diltiazem) have been shown to reduce both cardiovascular mortality and progression of diabetic nephropathy independent of an ACE inhibitor). Adapted with permission from Bakris et al. Am J Kidney Dis. 2000;36:646–661. ⁴