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[1]
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)"
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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)"
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| "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)"
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Diastolic Targets
| "1. Individuals with diabetes should be treated to a diastolic blood pressure goal of <90 mmHg (Level of Evidence: A)"
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| "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)"
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Treatment
| "1.Patients with blood pressure >120/80 mmHg should be advised on lifestyle changes to reduce blood pressure. (Level of Evidence: B)"
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| "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)"
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| "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)"
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| "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)"
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| "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)"
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| "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)"
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| "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)"
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| "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)"
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References
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