ENDOCRINE CONSULT / PEER REVIEWED

Hypertension and Diabetes: Addressing Common Comorbidities

Author and Disclosure Information

 

References

LIFESTYLE MANAGEMENT

Patients with diabetes and elevated blood pressure (> 120/80 mm Hg, per the 2017 ACC/AHA guidelines) are at high risk for hypertension and its complications.1,4 Lifestyle management—which includes weight loss, a healthy diet, increase in physical activity, and moderation in alcohol intake—is an important component of preventing or delaying a hypertension diagnosis.1,4

Both the ADA and the ACC/AHA recommend that patients with diabetes follow the Dietary Approaches to Stop Hypertension (DASH) diet.1,4 Guidelines include restricting sodium intake to < 2,300 mg/d, consuming 8-10 servings/d of fruits and vegetables and 2-3 servings/d of low-fat dairy products, limiting alcohol consumption to two servings/d for men and one serving/d for women, and increasing physical activity to include at least 30-45 min/d of aerobic exercise.1,4

PHARMACOLOGIC TREATMENT

Initial treatment for patients with hypertension and diabetes depends on the severity of the hypertension and should include drug classes that have demonstrated success in reducing ASCVD events: ACE inhibitors, angiotensin receptor blockers (ARBs), thiazide-like diuretics, and dihydropyridine calcium channel blockers. The ADA offers additional guidance:

Blood pressure ≥ 140/90 mm Hg should be treated with lifestyle modifications and simultaneous initiation of a single drug, with timely titration of pharmacologic therapy to achieve blood pressure goals.

Continue to: Blood pressure ≥ 160/100 mm Hg

Next Article: