Diabetes and Hypertension: A Position Statement by the American Diabetes Association

Abstract

Background The aims of this study were to investigate the effects of age, gender, body mass index (BMI), glycaemic control, socioeconomic status, dyslipidaemia, hypertension, ischaemic heart disease (IHD) and smoking status in type 2 diabetes in a population-based analysis. Methods Data were collected from 46 General Practice databases in 2009 and 2014. Cox regressions were run in the non-diabetes population plus type 2 diabetes patients. Results People with type 2 diabetes (n=16,643) had higher mortality rates than non-diabetes subjects. Ranked in order of Hazard Ratio (HR), increasing age (HR 2.31), smoking (HR 1.79), IHD (HR 1.65), deprivation (HR 1.36), hypertension (HR 1.23) and male gender (HR 1.20) all increased mortality risk (p<0.01). Statin therapy was associated with better outcome (HR 0.65, p<0.01). Abnormal lipid levels whilst not on a statin signi cantly increased mortality risk for raised total-cholesterol (HR 1.74) and low HDL-cholesterol (HR 1.48) but not for triglycerides (HR 0.67) (all p<0.01). Conclusions This large study con rmed that the all-cause mortality risk in people with type 2 diabetes remains elevated. In the study we demonstrated that a man with type 2 diabetes of 5-10 years duration who smoked, had hypertension and IHD plus lived in the most deprived area had a HR of 6.2 compared with a non-smoking, normotensive, non-diabetes subject without IHD living in the least deprived area.. Further research is required to understand the gender risk difference in all-cause mortality in type 1 compared with type 2 diabetes and why obesity plus raised triglycerides appear to be protective. Highlights Ranked in order of Hazard Ratio (HR), increasing age (HR 2.31), smoking (HR 1.79), Ischaemic Heart Disease (IHD) (HR 1.65), deprivation (HR 1.36), hypertension (HR 1.23) and male gender (HR 1.20) all increased mortality risk (p<0.01). This study demonstrated that a man with type 2 diabetes of 5-10 years duration who smoked, had hypertension and IHD plus lived in the most deprived area had a HR of 6.2 compared with a nonsmoking, normotensive, non-diabetes subject without IHD living in the least deprived area. Smoking prevalence decreased with duration falling from 26.8% for diabetes <5 yrs to 17.7% for diabetes >10 yrs. Body Mass Index > 30kg/m 2 appeared to reduce mortality risk (HR 0.77, p<0.01).

9. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2018

“…Moreover, numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications. Please refer to the American Diabetes Association (ADA) position statement "Diabetes and Hypertension" for a detailed review of the epidemiology, diagnosis, and treatment of hypertension (5).…”

“…Orthostatic blood pressure measurements should be checked on initial visit and as indicated. Home blood pressure self-monitoring and 24-h ambulatory blood pressure monitoring may provide evidence of white coat hypertension, masked hypertension, or other discrepancies between office and "true" blood pressure (5). In addition to confirming or refuting a diagnosis of hypertension, home blood pressure assessment may be useful to monitor antihypertensive treatment.…”

“…Based on these analyses, antihypertensive treatment appears to be beneficial when mean baseline blood pressure is $140/90 mmHg or mean attained intensive blood pressure is $130/80 mmHg (5,9,(12)(13)(14). Among trials with lower baseline or attained blood pressure, antihypertensive treatment reduced the risk of stroke, retinopathy, and albuminuria, but effects on other ASCVD outcomes and heart failure were not evident.…”

“…Patients and clinicians should engage in a shared decision-making process to determine individual blood pressure targets, with the acknowledgment that the benefits and risks of intensive blood pressure targets are uncertain and may vary across patients (5). Similar to the factors that influence management of hyperglycemia, factors that influence blood pressure treatment targets may include risks of treatment (e.g., hypotension, drug adverse effects), life expectancy, comorbidities including vascular complications, patient attitude and expected treatment efforts, and resources and support system (19).…”

Impact of the Discordance Between the American College of Cardiology/American Heart Association and American Diabetes Association Recommendations on Hypertension in Patients With Diabetes Mellitus in the United States

“…3 In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) published the new guideline for hypertension, 2 and the American Diabetes Association (ADA) also published a position statement for hypertension and diabetes mellitus. 4 The ACC/AHA recommended 130/80 mm Hg as the blood pressure (BP) threshold to define hypertension, whereas the ADA recommended 140/90 mm Hg. The authors of the ADA position statement emphasized the importance of an individualized approach to treat hypertension in patients with diabetes mellitus rather than changing the BP threshold.…”