15
Hypertension
Screening and Diagnosis
ÎMeasure blood pressure at every routine diabetes visit. Patients found to
have elevated should have blood pressure confirmed on a separate day. (B)
Goals
Î People with diabetes and hypertension should be treated to a systolic
blood pressure goal of <140 mmHg. (B)
Î Lower systolic targets, such as <130 mmHg, may be appropriate for
certain individuals, such as younger patients, if it can be achieved
without undue treatment burden. (C)
Î Patients with diabetes should be treated to a diastolic blood pressure
<80 mmHg. (B)
Treatment
Î Patients with blood pressure >120/80 mmHg should be advised on
lifestyle changes to reduce blood pressure. (B)
Î Patients with confirmed blood pressure >140/80 mmHg should,
in addition to lifestyle therapy, have prompt initiation and timely
subsequent titration of pharmacologic therapy to achieve blood
pressure goals. (B)
Î Lifestyle therapy for hypertension consists of:
• Weight loss, if overweight
• Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern
including reducing sodium and increasing potassium intake
• Moderation of alcohol intake
• Increased physical activity (B)
Î Pharmacologic therapy for patients with diabetes and hypertension
should include either an angiotensin-converting enzyme (ACE) inhibitor
or an angiotensin receptor blocker (ARB).
Note: If one class is not tolerated, the other should be substituted. (C)
Î Multiple drug therapy (two or more agents at maximum doses) is
generally required to achieve blood pressure targets. (B)
Î Administer one or more antihypertensive medications at bedtime. (A)
Î If ACE inhibitors, ARBs, or diuretics are used, serum creatinine/
estimated glomerular filtration rate (eGFR) and serum potassium
levels should be monitored. (E)
Î In pregnant patients with diabetes and chronic hypertension, consider
blood pressure target goals of 110-129/65-79 mmHg in the interest of
long-term maternal health and minimizing impaired fetal growth. (E)
Note: ACE inhibitors and ARBs are contraindicated during pregnancy.
