Hypertension Management in Adults With Diabetes
- American Diabetes Association
- ACE, angiotensin-converting enzyme
- ALLHAT, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
- ARB, angiotensin receptor blocker
- DCCB, dihydropyridine calcium channel blocker
- HOT, Hypertension Optimal Treatment
- JNC VI, Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
- UKPDS, U.K. Prospective Diabetes Study
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.
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.” 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 with reductions …
