DiabetesHypertension Management in adults

DiabetesHypertension Management in adults

Evidence review: hypertension as a risk factor for complications of diabetes

Diabetes increases the risk of coronary events twofold in men and fourfold in women. Part of this increase is due to the frequency of associated cardiovascular risk factors such as hypertension, dyslipidemia, and clotting abnormalities. More …

DiabetesHypertension Management in Adults

DiabetesHypertension Management in adults

Evidence for target levels of blood pressure in patients with diabetes

The UKPDS and the Hypertension Optimal Treatment (HOT) trial both demonstrated improved outcomes, especially in preventing stroke, in patients assigned to lower blood pressure targets. Optimal outcomes in the HOT study were achieved in the group with a target diastolic blood pressure of 80 mmHg (achieved 82.6 mmHg). More …

DiabetesHypertension Management in Adults

DiabetesHypertension Management in Adults

Evidence for non-drug management of hypertension

Dietary management with moderate sodium restriction has been effective in reducing blood pressure in individuals with essential hypertension. Several controlled studies have looked at the relationship between weight loss and blood pressure reduction. Weight reduction can reduce blood pressure independent of sodium intake and also can improve blood glucose and lipid levels. The loss of one kilogram in body weight has resulted in decreases in mean arterial blood pressure of 1 mmHg. The role of very low calorie diets and pharmacologic agents that induce weight loss in the management of hypertension in diabetic patients has not been adequately studied. Some appetite suppressants may induce increases in blood pressure levels, More …

American Diabetes Association

DiabetesHypertension Management in Adults

DiabetesHypertension Management in Adults

Evidence for drug therapy of hypertension

There are a number of trials demonstrating the superiority of drug therapy versus placebo in reducing outcomes including cardiovascular events and microvascular complications of retinopathy and progression of nephropathy. These studies used different drug classes, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, and ß-blockers, as the initial step in therapy. All of these agents were superior to placebo; however, it must be noted that many patients required three or more drugs to achieve the specified target levels of blood pressure control. More …

American Diabetes association

DiabetesHypertension Management in Adults

DiabetesHypertension Management in Adults

Summary

There is a strong epidemiological connection between hypertension in diabetes and adverse outcomes of diabetes. Clinical trials demonstrate the efficacy of drug therapy versus placebo in reducing these outcomes and in setting an aggressive blood pressure–lowering target of <130/80 mmHg. It is very clear that many people will require three or more drugs to achieve the recommended target. Achievement of the target blood pressure goal with a regimen that does not produce burdensome side effects and is at reasonable cost to the patient is probably more important than the specific drug strategy. More …

American Diabetes Association

DiabetesHypertension Management in Adults

DiabetesHypertension Management in Adults

Treatment

A-Level evidence:

• Patients with diabetes should be treated to a diastolic blood pressure <80 mmHg.
• Patients with a systolic blood pressure of 130–139 mmHg or a diastolic blood pressure of 80–89 mmHg should be given lifestyle/behavioral therapy alone for a maximum of 3 months and then, if targets are not achieved, should also be treated pharmacologically.
• Patients with hypertension (systolic blood pressure 140 mmHg or diastolic blood pressure 90 mmHg) should receive drug therapy in addition to lifestyle/behavioral therapy.

Initial drug therapy may be with any drug class currently indicated for the treatment of hypertension. However, some drug classes More …

American Diabetes Association