Managing hypertension in patients with diabetes

(Clinical Advisor) — The CDC estimates that 31% of U.S. adults have hypertension, with that proportion rising to nearly 70% among adults with diabetes – and those with both conditions are at increased risk for complications including stroke, coronary artery disease (CAD), peripheral artery disease (PAD), eye problems, kidney disease and neuropathy.

Fortunately, hypertension management strategies can go a long way towards reducing these complications. Data from the U.K. Prospective Diabetes Study (UKPDS) indicated that decreasing mean systolic BP by 10 mm Hg resulted in a 12% reduction in the risk for diabetes-related complications, a 15% reduction in diabetes-related deaths and an 11% reduction in myocardial infarction.3

There are many medications and lifestyle modifications available to help patients with diabetes lower their BP, but recognizing hypertension is the first step. Clinicians should check BP levels at every appointment to confirm that patients are within the healthy range. The American Diabetes Association (ADA) recommends a slightly lower cut-off point for diagnosing hypertension in patients with diabetes because of the well-established risk for cardiovascular disease: BP ≥130/80 mm Hg vs. BP ≥140/90 mm Hg.

For adult diabetes patients with slight BP elevations (130-139 mm Hg systolic BP, 80-89 mm Hg diastolic BP) diet and exercise may be sufficient to achieve target BP levels. But if no changes occur after three months, clinicians should consider initiating drug therapy.

Adult patients with systolic BP ≥140 mm Hg and diastolic BP ≥ 90 mm Hg should receive medication upon diagnosis, in addition to lifestyle counselling.


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