Hypertension in Adults With Diabetes :Screening and diagnosis

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Hypertension in Adults With Diabetes :Screening and diagnosis
Diabetes Care


Expert opinion:

Blood pressure should be measured at every routine diabetes visit. Patients found to have systolic blood pressure >=130 mmHg or diastolic blood pressure >=80 mmHg should have blood pressure confirmed on a separate day.
Orthostatic measurement of blood pressure should be performed to assess for the presence of autonomic neuropathy.

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 (ACE inhibitors, ß-blockers, and diuretics) have been repeatedly shown to be particularly beneficial in reducing CVD events during the treatment of uncomplicated hypertension and are therefore preferred agents for initial therapy. If ACE inhibitors are not tolerated, ARBs may be used. Additional drugs may be chosen from these classes or another drug class. (A)
If ACE inhibitors or ARBs are used, monitor renal function and serum potassium levels. (E)
In patients with type 1 diabetes, with or without hypertension, with any degree of albuminuria, ACE inhibitors have been shown to delay the progression of nephropathy. (A) • In patients with type 2 diabetes, hypertension and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) • In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), nephropathy, or renal insufficiency, an ARB should be strongly considered. If one class is not tolerated, the other should be substituted.
In patients over age 55 years, with hypertension or without hypertension but with another cardiovascular risk factor (history of cardiovascular disease, dyslipidemia, microalbuminuria, smoking), an ACE inhibitor (if not contraindicated) should be considered to reduce the risk of cardiovascular events.
In patients with a recent myocardial infarction, ß-blockers, in addition, should be considered to reduce mortality.

© 2003 by the American Diabetes Association, Inc.