Treatment of hypertension in diabetes: a contemporary approach with a focus on improving cardiovascular outcomes

Abstract

Diabetes mellitus and hypertension are interrelated conditions that predispose patients to cardiovascular disease. The 2015 American Diabetes Association guidelines recommend a blood pressure goal of <140/90 but indicates that a lower goal can be set for some individuals if this can be achieved without undue burden. Renin angiotensin system blockers remain the main stay of treatment in hypertensive diabetics together with lifestyle interventions. Guidelines indicate that combination therapy may be initiated in patients who have a blood pressure 20/10 over the target BP. As discussed in this review, there are several diabetic medications that have antihypertensive effects. Management of hypertension in diabetes mellitus is an important factor in reducing cardiovascular disease in conjunction with other cardiovascular disease prevention strategies such as use of stains and aspirin. Patients will benefit from multidisciplinary team expertise including a primary care provider, endocrinologist, hypertension specialist, diabetic educator and dietician.

KEYWORDS:

• diabetes
• hypertension
• cardiovascular
• disease
• guidelines

Acknowledgments

The authors thank Brenda Hunter and Meg Duffy for help with the preparation of this manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key Issues

• DM and HTN are two inter-related dis.eases that independently increase cardiovascular risk

• Both are part of the cardiorenal metabolic syndrome

• 2015 American Diabetes Association guidelines recommend an overall BP goal of less than 140/90mmHg but a lower goal for certain individuals

• Recent NIH Trial-SPRINT showed that lowering systolic BP to 120 as opposed to 140, significantly reduced CVD and mortality in patients over the age of 50 (This study was done in non-diabetic patients)

• Life style management remains a corner stone of HTN management

• Renin angiotensin system blockers remain the main stay of treatment in HTN complicating diabetes.

• Patients with CKD and diabetes have a high risk of CVD compared to diabetics without CKD.

• There are several diabetic medications that can modify cardiovascular risk factors independent of their antidiabetic effect

• Metformin and Emfloglozin are two diabetic drugs that have shown reduced cardiovascular risk

• Ambulatory BP monitoring gives a more accurate BP measurement than an in clinic measurement