Treating Diabetes

● Patients with a systolic blood pressure of 130–139 mmHg or a diastolic blood pressure of 80–89mmHg may be given lifestyle therapy alone for a maximum of 3 months and then, if targets are not achieved, be treated with addition of pharmacological agents.

● Patients with more severe hypertension (systolic blood pressure
140 or diastolic blood pressure
90 mmHg) at diagnosis or follow-up should receive pharmacologic therapy in addition to lifestyle therapy.

● Pharmacologic therapy for patients with diabetes and hypertension should be with a regimen that includes either an ACE inhibitor or an angiotensin receptor blocker (ARB). If one class is not tolerated, the other should be substituted. If needed to achieve blood pressure targets, a thiazide diuretic should be added to those with an estimated glomerular filtration rate (GFR) (see below)
50 ml/min per 1.73 m2 and a loop diuretic for those with an estimated GFR 50 ml/min per 1.73 m2.

● Multiple drug therapy (two or more agents at maximal doses) is generally required to achieve blood pressure targets.

● If ACE inhibitors, ARBs, or diuretics are used, kidney function and serum potassium levels should be closely monitored.

● In pregnant patients with diabetes and chronic hypertension, blood pressure target goals of 110–129/65–79 mmHg are suggested in the interest of longterm maternal health and minimizing impaired fetal growth. ACE inhibitors and ARBs are contraindicated during pregnancy. Hypertension is a common comorbidity of diabetes, affecting the majority of patients, with prevalence depending on type of diabetes, age, obesity, and ethnicity. Hypertension is a major risk factor for both CVD and microvascular complications. In type 1 diabetes, hypertension is often the result of underlying nephropathy, while in type 2 diabetes it usually coexists with other cardiometabolic risk factors.