Guidelines for Hypertension Treatment in Diabetes Patients Updated

Hypertension is common among patients with diabetes and, if uncontrolled, can lead to significant cardiovascular damage and adverse events.

Recently, a panel of 9 diabetes experts reviewed and updated hypertension treatment guidelines for patients with diabetes on behalf of the American Diabetes Association (ADA). The revised recommendations, published in Diabetes Care, were based on an extensive review of research.

The experts noted that the risk of hypertension is based on patient health, age, gender, family history, and genetics.

The condition is also a known predictor of atherosclerotic cardiovascular disease (ASCVD), which can cause myocardial infarction, stroke, and peripheral arterial disease. ASCVD is the leading cause of morbidity and mortality among patients with diabetes and also is a significant contributor to diabetes-related costs, according to the ADA.

It has been established that controlling hypertension reduced ASCVD-related events, heart failure, and other complications in patients with diabetes.

The ADA recommends that patients with diabetes have their blood pressure checked at every routine physician visit. Patients with confirmed hypertension should check their blood pressure at home, according to the guidelines.

Patients should also be checked for orthostatic hypertension, which is a condition that may signal nerve damage and change blood pressure targets and treatment. Patients can be checked for the condition by taking their blood pressure standing up, the ADA reported.

The ADA recommends that patients with diabetes and hypertension should aim for a blood pressure target of less than 140/90-mmHg, although a lower target may be optimal for patients with a high risk of cardiovascular disease, according to the guidelines.

The association also recommends that patients lose weight, eat a healthy diet, and increase physical activity to lower blood pressure.

The guidelines include step-by-step recommendations for medication-assisted treatment, which depends on initial blood pressure, kidney function, treatment response, and adverse events, according to the ADA.

The novel guidelines also provide information about pregnancy among women with diabetes and hypertension. The ADA positions that pregnant women with preexisting hypertension or mild gestational hypertension with no end-organ damage should not be treated with anti-hypertensive drugs. In these patients, it is unclear whether the benefit of controlled hypertension outweighs the risks.

Additionally, the ADA recommends that patients with diabetes who do not have hypertension should not be treated with antihypertensive drugs, as there is unsubstantial evidence that antihypertensive drugs improve outcomes among these patients.

“In the past 2 decades, we have seen a decrease in ASCVD morbidity and mortality in people with diabetes, and evidence indicates that advances in blood pressure control are likely the key to such improvements,” said the William T. Cefalu, MD, chief scientific, medical and mission officer at the ADA. “As medical and pharmacological developments occur, it is imperative that medical providers, diabetes educators and patients stay abreast of the most current care recommendations that can lead to improved cardiovascular health for people with diabetes and will ultimately result in better overall health and fewer diabetes-related complications.”