The American Diabetes Association (ADA) has recently updated its guidelines on the assessment, treatment, and lifestyle management of hypertension in patients with diabetes.
Hypertension is significantly associated with the risk of developing atherosclerotic cardiovascular disease (ASCVD). However, treating hypertension can reduce ASCVD events, heart failure and microvascular complications among patients with diabetes.
After reviewing its existing guidelines, the ADA has made the following recommendations:
- Patients with diabetes should have blood measurements taken at every clinical visit, and those with hypertension should have measurements taken at home as well.
- Blood pressure should be measured while standing at the initial clinical evaluation to assess for orthostatic hypertension.
- Patients with diabetes with an elevated blood pressure of 140/90 mmHg and above should have their blood pressure taken multiple times and on separate days to assess for hypertension.
- Although the ADA recommends a blood pressure target of less than 140/90 mmHg for most patients with diabetes and hypertension, some patients with a high risk of cardiovascular disease may benefit from a lower blood pressure target.
- Pregnant women with preexisting hypertension or mild gestational hypertension (defined as blood pressures below 160/105 mmHg), and no evidence of end-organ damage, should not be treated with antihypertensive medications. There is no benefit that clearly outweighs the potential risks among this patient population.
In their update, the ADA also provided recommendations on lifestyle management plans for the treatment of hypertension among patients with diabetes, including weight loss, nutrition and increased physical activity. Additionally, the update addressed the use of medication among this patient population, which depends on multiple factors like initial blood pressure, kidney health, response to treatment, and adverse effects.
“In the past two 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 William T. Cefalu, MD, of 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.”—Christina Vogt