Helping Patients With Diabetes Take Control of Their BP

Research has shown that most patients with type 2 diabetes also have comorbid hypertension, with the prevalence depending on other factors, such as cardiovascular disease (CVD), microvascular and macrovascular complications, age, obesity, and ethnicity. “Some studies have estimated that as many as 60% to 70% of people with diabetes also suffer from high blood pressure (BP),” says Carol H. Wysham, MD. “In type 2 diabetes, hypertension usually coexists with other cardiometabolic risk factors. The risk for macrovascular complications in patients with diabetes who have hypertension is doubled. Both hypertension and diabetes affect the same major target organs.” According to the American Diabetes Association’s Standards of Medical Care in Diabetes-2011, lowering BP to less than 130/80 mm Hg is the primary goal in the management for most hypertensive patients with diabetes (Table 1). “This cut-off for a diagnosis of hypertension is lower in people with diabetes than in those without diabetes—for whom the recommended BP is 140/90 mm Hg— because of the clear synergistic risks of hypertension and diabetes,” says Dr. Wysham. Randomized clinical trials have demonstrated the benefits of lowering BP, including reductions in CVD events, stroke, and nephropathy. Treatment Goals to Reduce Blood Pressure Recent data from landmark clinical investigations have had mixed results with regard to using various BP thresholds for patients with diabetes. These studies indicate that systolic BP targets may vary for individual patients based on responses to therapy, medication tolerance, and individual characteristics. “It’s important for clinicians to keep in mind that most of these analyses have suggested that outcomes are worse if the systolic BP is greater than 140 mm Hg,” Dr. Wysham says....