| Abstract | | A 63-year-old male Caucasian patient with arterial hypertension, type 2 diabetes, and a history of chest pain and dyspnoea during exertion is reported on here. He also had a history of coronary artery bypass grafting, stenting of the right carotid artery, and microvascular and macrovascular complications of diabetes. On the basis of normal creatine kinase - isoenzyme MB (CK-MB), total CK, and troponin T levels, cardiac damage was ruled out. Subsequently, submaximal-stress testing was performed demonstrating reversible myocardial ischaemia. Coronary angiography showed significant stenosis in the proximal and mid portions of the left anterior descending artery. He was treated with telmisartan 40 mg once daily, ramipril 10 mg once daily, slow-release indapamide 1.5 mg once daily, carvedilol 12.5 mg twice daily, lacidipine 4 mg once daily, acetylsalicylic acid 100 mg once daily, atorvastatin 80 mg once daily, biphasic insulin (30% short-acting, 70% long-acting), and glucophage 850 mg twice daily. In conclusion, diabetic patients with arterial hypertension and atherosclerosis need an intensified therapy that goes beyond blood pressure lowering. Inhibitors of the renin-angiotensin-aldosterone system (RAAS) not only reduce blood pressure but also have beneficial effects on remodelling, inflammation, and atherosclerosis. In order to optimize therapy in type 2 diabetic patients, RAAS-blocking agents should be added to their therapeutic regimen.
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