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Treatment of Hypertension in Adults With Diabetes

	INTRODUCTION

 
Hypertension (defined as a blood pressure 140/90 mmHg) is an extremely common comorbid condition in diabetes, affecting 20–60% of patients with diabetes, depending on obesity, ethnicity, and age. In type 2 diabetes, hypertension is often present as part of the metabolic syndrome of insulin resistance also including central obesity and dyslipidemia. In type 1 diabetes, hypertension may reflect the onset of diabetic nephropathy. Hypertension substantially increases the risk of both macrovascular and microvascular complications, including stroke, coronary artery disease, and peripheral vascular disease, retinopathy, nephropathy, and possibly neuropathy. In recent years, adequate data from well-designed randomized clinical trials have demonstrated the effectiveness of aggressive treatment of hypertension in reducing both types of diabetes complications.

	Scope

 
These recommendations are intended to apply to nonpregnant adults with type 1 or type 2 diabetes mellitus.

	Target audience

 
These recommendations are intended for the use of health care professionals who care for patients with diabetes and hypertension, including specialist and primary care physicians, nurses and nurse practitioners, physicians’ assistants, educators, dietitians, and others.

	Method

 
These recommendations are based on the American Diabetes Association Technical Review "Treatment of Diabetes in Adult Patients with Hypertension" (1). A technical review is a systematic review of the medical literature that has been peer-reviewed by the American Diabetes Association’s Professional Practice Committee.

	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. In observational studies, people with both diabetes and hypertension have approximately twice the risk of cardiovascular disease as nondiabetic people with hypertension. Hypertensive diabetic patients are also at increased risk for diabetes-specific complications including retinopathy and nephropathy. In the U.K. Prospective Diabetes Study (UKPDS) epidemiological study, each 10-mmHg decrease in mean systolic blood pressure was associated . . . [Full Text of this Article]

	Evidence for target levels of blood pressure in patients with diabetes

 

	Evidence for non-drug management of hypertension

 

	Evidence for drug therapy of hypertension

 

	Summary

 

	Recommendations

 

	Screening and diagnosis

 
Expert opinion:

	Treatment

 
A-level evidence:
B-level evidence:
C-level evidence:
Expert consensus

	Footnotes

 

	Bibliography

 

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