Patients with diabetes often have numerous comorbid conditions such as obesity, heart disease, kidney disease and hypertension to name a few. Hypertension or high blood pressure (BP), in particular, can lead to increased risks for atherosclerotic cardiovascular disease (ASCVD), heart failure (HF) and attendant microvascular complications.
The last time the American Diabetes Association (ADA) provided a position statement on hypertension was more than 15 years ago. Given the increasing rise in the numbers of people afflicted by diabetes, increased BMI and obesity, it is timely that this body has revised its statement on hypertension in this patient population. Predominantly focusing on type 2 diabetes (T2D), the position statement can be summarized as follows:
- Regular monitoring of BP in the office and in the home
- Careful assessment and implementation of all antihypertensive medications and supplements particularly in patients with known kidney disease or clinical proteinuria (≥300 mg albumin/g creatinine)
- A BP goal for all diabetics of <140/90 mm Hg based on clinical evidence
- With individualization of targets if <130/80 mm Hg based on severity of CV risk and
side effects
- With individualization of targets if <130/80 mm Hg based on severity of CV risk and
The position statement also describes in detail how BP should be taken at every clinic visit, with repeated measurements to confirm the diagnosis of hypertension, the use of home BP measurement to confirm the elevations that may be seen during the clinic visit, and the importance of checking for orthostatic hypotension at the initial hypertension visit and periodically thereafter. This highlights the importance of autonomic instability in diabetes.
Overall, this document is an important read for the practitioner who cares for patients with diabetes and hypertension. These guidelines should enable these patients to continue to receive optimal care which has led to a reduction in their rates of CV disease morbidity and mortality over the past 2 decades.
Citation
- de Boer IH, Bangalore S, Benetos A, et al. Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(9):1273-1284.
