When evaluating and treating a patient with diabetes, it is important to consider
- What is the patient’s overall risk for atherosclerotic cardiovascular disease?
- Does he/she have an increased risk for stroke? If so, lower blood pressure targets may be appropriate.
- Is more than one antihypertensive agent (ACE inhibitor, ARB, or diuretic) being used? If so, close monitoring of estimated glomerular filtration rate and potassium (as well as other indications of adverse effects) is important.
The treatment regimen should be a shared decision-making process between the clinician and patient and should be individualized to each patient and his/her existing comorbidities.
Clinical trials and meta-analyses support target blood pressure management to < 140/90 mm Hg in most adults with diabetes, while lower targets (< 130/80 mm Hg) may be beneficial for patients with diabetes and a high risk for cardiovascular disease.1,5 Lifestyle management should be initiated and continued in patients with a blood pressure > 120/80 mm Hg and in those diagnosed with hypertension.1 Medications that reduce cardiovascular events should be used in management, with ACE inhibitors or ARBs being firstline treatment in patients with albuminuria.1
For more information on hypertensive treatment in special populations (eg, pregnant women and older adults), see the ADA’s full position statement.1