Hypertension and Blood Pressure Control in Diabetics

2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
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2016 ADA Standard of Medical Care Guideline Recommendations
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Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
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Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]

2016 ADA Standards of Medical Care in Diabetes Guidelines

SCREENING and DIAGNOSIS

"1.Blood pressure should be measured at every routine visit. Patients found to have elevated blood pressure should have blood pressure confirmed on a separate day. (Level of Evidence: B)"

GOALS

Systolic Targets

"1. People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg (Level of Evidence: A)"

"2. Lower systolic targets, such as <130 mmHg, may be appropriate for certain indi- viduals with diabetes, such as younger patients, those with albuminuria, and/or those with hypertension and one or more additional atherosclerotic cardiovascular disease risk factors, if they can be achieved without undue treatment burden. (Level of Evidence: C)"

Diastolic Targets

"1. Individuals with diabetes should be treated to a diastolic blood pressure goal of <90 mmHg (Level of Evidence: A)"

"2.Lower diastolic targets, such as <80 mmHg, may be appropriate for certain indi- viduals with diabetes, such as younger patients, those with albuminuria, and/or those with hypertension and one or more additional atherosclerotic cardiovascular disease risk factors, if they can be achieved without undue treatment burden. (Level of Evidence: B)"

Treatment

"1.Patients with blood pressure >120/80 mmHg should be advised on lifestyle changes to reduce blood pressure. (Level of Evidence: B)"

"2. Patients with confirmed office-based blood pressure >140/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely subsequent titration of pharmacological therapy to achieve blood pressure goals. (Level of Evidence: A)"

"3.In older adults, pharmacological therapy to achieve treatment goals of <130/70 mmHg is not recommended; treating to systolic blood pressure <130 mmHg has not been shown to improve cardiovascular out- comes and treating to diastolic blood pressure <70 mmHg has been associated with higher mortality(Level of Evidence: C)"

"4.Lifestyle therapy for elevated blood pressure consists of weight loss, if overweight or obese; a Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern includ- ing reducing sodium and increasing potassium intake; moderation of alcohol intake; and increased physical activity. (Level of Evidence: B)"

"5.Pharmacological therapy for patients with diabetes and hypertension should comprise a regimen that includes either an ACE inhibitor or an angiotensin receptor blocker but not both. B If one class is not tolerated, the other should be substituted. (Level of Evidence: C)"

"6.Multiple-drug therapy (including a thiazide diuretic and ACE inhibitor/ angiotensin receptor blocker, at maximal doses) is generally required to achieve blood pressure targets. (Level of Evidence: B)"

"7.If ACE inhibitors, angiotensin receptor blockers, or diuretics are used, serum creatinine/estimated glomerular filtration rate and serum potas- sium levels should be monitored. (Level of Evidence: E)"

"8.In pregnant patients with diabetes and chronic hypertension, blood pressure targets of 110–129/65–79 mmHg are suggested in the interest of optimizing long-term maternal health and minimizing impaired fetal growth. (Level of Evidence: E)"