Moreover， Impaired glucose metabolism and diabetes substantially interact with hypertension to increase the risk of cardiovascular disease. It is therefore of importance to prevent the development of new-onset diabetes， if possible. This can be achieved by lifestyle intervention， but also by some selected drugs. Examples of drugs with a proven effect to prevent diabetes are metformin as well as agents that block the renin-angiotensin system. In the recent NAVIGATOR study it was shown that treatment with valsartan， an angiotensin-2 receptor blocker， reduced the development of type 2 diabetes with 14% over 5 years in 9306 subjects with impaired glucose tolerance (IGT) [3].

    In conclusion， the prevention of diabetes complications， most notably in the vascular system， takes a multi-factorial intervention approach as previously proven effective in the Steno-2 trial [4]. However， the recent introduction of more flexible goals for control of hyperglycaemia and hypertension will increase the importance of the clinical consultation and the clinical skills of individual physician to correctly asses risk factors， evaluate overall cardiovascular risk and tailor the therapy to the individual. In the end this opens up a door for a better understanding of risk and treatment effects， as well as making the patient a partner in discussions on risk and how to cope with it in an evidence-based way.

References

1. Nilsson PM， Boutouyrie P， Laurent S. Vascular aging: A tale of EVA and ADAM in cardiovascular risk assessment and prevention. Hypertension 2009;54:3-10.

2. Mancia G， Laurent S， Agabiti-Rosei E， Ambrosioni E， Burnier M， Caulfield MJ，et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009 Oct 15. [Epub ahead of print]

3. The NAVIGATOR Study Group. Effect of Valsartan on the Incidence of Diabetes and Cardiovascular Events. N Engl J Med. 2010 Mar 29. [Epub ahead of print]4. Gaede P， Lund- Andersen H， Parving HH， Pedersen O. Effect of a multifactorial intervention on mortality in type 2diabetes. N Engl J Med. 2008;358:580-91.

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