Gaining Control of Hypertension Early in Patients With Diabetes

Gaining Control of Hypertension Early in Patients With Diabetes

Hypertension is a common comorbidity of diabetes that increases risks for cardiovascular disease (CVD) and microvascular complications. Most patients with diabetes have hypertension, but the prevalence can vary depending on the type of diabetes, age, obesity, and ethnicity. For example, in type 1 diabetes, hypertension is often the result of underlying nephropathy. In type 2 diabetes, hypertension usually coexists with other cardiometabolic risk factors. Important Revisions Each year, the American Diabetes Association updates its Standards of Medical Care in Diabetes. In the 2013 update, the standards revised recommendations to include changing the treatment goal for high blood pressure (BP) from less than 130 mm Hg to less than 140 mm Hg (Table 1). “This change to the standards of medical care was made based on several new meta-analyses that showed there is little additional benefit to achieving the lower BP targets,” explains Richard W. Grant, MD, MPH. Clinical trials have shown that the health benefits to targeting a BP goal of less than 140 mm Hg—including the reduction of CVD events, stroke, and nephropathy—offered little benefit with more intensive BP treatment. Research has shown that such approaches do not significantly reduce mortality rates or the rate of non-fatal heart attacks. There is a small but statistically significant benefit in terms of reducing the risk of stroke, but this comes at the expense of needing more medications and higher rates of side effects. According to Dr. Grant, the change in the “default” systolic BP target is not meant to downplay the importance of treating hypertension in patients with diabetes. “Untreated hypertension can be very dangerous,” he says. “The change also doesn’t imply that...

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....