Diabetes mellitus: hypertension management
Diabetes mellitus: hypertension management
Patient with diabetes mellitus have traditionally had their blood pressure controlled more aggressively to help reduce their overall cardiovascular risk. However, a 2013 Cochrane review cast doubt on the wisdom of lower blood pressure targets for patients with diabetes. It compared patients who had tight blood pressure control (targets < 130/85 mmHg) with more relaxed control (< 140-160/90-100 mmHg). Patients who were more tightly controlled had a slightly reduced rate of stroke but otherwise, outcomes were not significantly different.In light of this, NICE recommends a blood pressure target of < 140/90 mmHg for type 2 diabetics, the same as for patients without diabetes.
For patients with type 1 diabetes, NICE recommends:
Intervention levels for recommending blood pressure management should be 135/85 mmHg unless the adult with type 1 diabetes has albuminuria or 2 or more features of metabolic syndrome, in which case it should be 130/80 mmHg
Because ACE inhibitors/or angiotensin-II receptor antagonist (A2RBs) have a renoprotective effect in diabetes they are the first-line antihypertensive regardless of age. A2RBs are preferred for black African or African-Caribbean diabetic patients. Further management then reverts to that of non-diabetic patients.
Remember that autonomic neuropathy may result in more postural symptoms in patients taking antihypertensive therapy.
The routine use of beta-blockers in uncomplicated hypertension should be avoided, particularly when given in combination with thiazides, as they may cause insulin resistance, impair insulin secretion and alter the autonomic response to hypoglycaemia.
+PassMedicine Notes
Patient with diabetes mellitus have traditionally had their blood pressure controlled more aggressively to help reduce their overall cardiovascular risk. However, a 2013 Cochrane review cast doubt on the wisdom of lower blood pressure targets for patients with diabetes. It compared patients who had tight blood pressure control (targets < 130/85 mmHg) with more relaxed control (< 140-160/90-100 mmHg). Patients who were more tightly controlled had a slightly reduced rate of stroke but otherwise, outcomes were not significantly different.
In light of this, NICE recommends a blood pressure target of < 140/90 mmHg for type 2 diabetics, the same as for patients without diabetes.
For patients with type 1 diabetes, NICE recommends:
Intervention levels for recommending blood pressure management should be 135/85 mmHg unless the adult with type 1 diabetes has albuminuria or 2 or more features of metabolic syndrome, in which case it should be 130/80 mmHg
Because ACE inhibitors/or angiotensin-II receptor antagonist (A2RBs) have a renoprotective effect in diabetes they are the first-line antihypertensive regardless of age. A2RBs are preferred for black African or African-Caribbean diabetic patients. Further management then reverts to that of non-diabetic patients.
Remember that autonomic neuropathy may result in more postural symptoms in patients taking antihypertensive therapy.
The routine use of beta-blockers in uncomplicated hypertension should be avoided, particularly when given in combination with thiazides, as they may cause insulin resistance, impair insulin secretion and alter the autonomic response to hypoglycaemia.