However, the results of ACCORD and SPRINT were generally In addition, a SPRINT substudy demonstrated that patients with prediabetes derived a benefit similar to that of patients with normoglycemia.S9.6-8 Previous trials have shown similar quantitative benefits from lowering BP in persons with and without DM.S9.6-9 2. BP control is more difficult to achieve in patients with DM than in those without DM, necessitating use of combination therapy in the majority of patients.S9.6-27 All major antihypertensive drug classes (ie, ACE inhibitors, ARBs, CCBs, and diuretics) are useful in the treatment of hypertension in DM.S9.6-1,S9.6-9 However, in ALLHAT, doxazosin was clearly inferior to chlorthalidone, which Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e59 also reduced some events more than amlodipine or 3. ACE inhibitors and ARBs have the best efficacy among the drug classes on urinary albumin excretionS9.6-12 (see Section 9.3). Therefore, an ACE inhibitor or ARB may be considered as part of the combination. A meta- analysis of RCTs of primary prevention of albumin- uria in patients with DM demonstrated a significant reduction in progression of moderately to severely in- creased albuminuria with the use of ACE inhibitors or 9.7. Metabolic Syndrome Metabolic syndrome is a state of metabolic dysregulation characterized by visceral fat accumulation, insulin resis- tance, hyperinsulinemia, and hyperlipidemia, as well as pre- disposition to type 2 DM, hypertension, and atherosclerotic According to data from the NHANES III and the prevalence of metabolic syndrome in the United States was 34.2% in 2006 and has likely increased substantially since that time. 