Hypertension in Diabetes Patients - Diabetic Hypertension Treatment

Hypertension in Diabetes Patients
U.S. Pharmacist Vol. No: 28:11 Posted: 11/15/03
M. Saljoughian, PharmD, PhD, Department of Pharmacy, Alta Bates Summit Medical Center
Berkeley, California

Hypertension should be treated aggressively in diabetic patients, especially if there is evidence of renal disease. Hypertension is a "silent" disease with no obvious symptoms; as a result, most patients do not seek medical attention. It is twice as common in people with diabetes, and, in most patients, multiple checks may be required to confirm a diagnosis. Hypertension contributes to the development and progression of the chronic complications of diabetes, such as retinopathy, nephropathy, and various forms of cardiovascular disease. By achieving and maintaining blood pressure within the normal ranges, the risk of other complications can be minimized. In other words, tight blood pressure control is associated with fewer diabetes-related deaths. Approximately 65% of people with diabetes die from heart disease and stroke.1

Lifestyle changes in people with diabetes are the first step towards the treatment of hypertension. Making nutritional changes, losing weight, increasing physical activity, and limiting alcohol intake are some steps that should be taken. The second step is pharmacotherapy, especially in patients with blood pressure of 140/90 mmHg or higher.1 Diabetic patients need ongoing support from their families and caregivers to make and maintain these changes. In fact, caregivers have a tremendous role in the health and well-being of the person with diabetes and hypertension.

Because some antihypertensive medications may worsen diabetes control and have unpleasant side effects, they are not taken as prescribed. The question is which antihypertensive drug has the best possible outcome and least undesirable effects in patients with diabetes and hypertension. In any event, patients with diabetes require ongoing monitoring and support to get the maximum benefit from changes in their lifestyle and from their antihypertensive medication. According to the American Diabetes Association, 71% of people with diabetes have hypertension and only 12% have well-controlled blood pressure.1

Overall, the Joint National Committee recommends three blood pressure goals: < 140/90 mmHg for uncomplicated hypertension; < 130/80 mmHg for hypertensive patients with diabetes; and < 125/75 mmHg for patients with renal insufficiency and proteinuria less than 1 g/24 h.

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