How to Manage Hypertension in People With Diabetes

Abstract

Hypertension is a common condition that is often seen in patients with diabetes. Both diseases increase the risk of morbidity and mortality from CV events and kidney disease progression. Factors that influence blood pressure control in diabetes include the persons' genetic background for hypertension and kidney disease, level of obesity and insulin resistance, the magnitude of pre-existing kidney disease, and lifestyle factors such as level of sodium and potassium intake, sleep quality and exercise effort all of which can affect levels of sympathetic nerve activity and contribute to increased blood pressure variability. Lifestyle intervention is a key component to the effective management of diabetes and hypertension and can markedly reduce event rates of both heart and kidney outcomes. The approach to pharmacologic treatment of blood pressure in diabetes is crucial since certain classes of agents for both blood pressure and diabetes confer significant benefits to reduce cardiorenal outcomes.

Effect of Sodium Glucose Co-Transporter 2 Inhibitors on Lipid Levels in Newly Diagnosed Hypertensive Patients With Type 2 Diabetes Mellitus

“…Lifestyle changes play important roles in the management of both diabetes and hypertension (17). However, this may not be sufficient for glycemic control and blood pressure.…”

Hipertensión y diabetes mellitus en la mujer: una combinación de alto riesgo

“…The goals of treatment with changes in lifestyle and drugs must be individualized, considering cardiovascular risk, possible adverse drug reactions (ADR) to antihypertensives, and the patient's characteristics. [6][7][8] In patients with T2DM and blood pressure (BP) levels greater than 130/80 mmHg, it is recommended to start antihypertensive drug treatment. The recommended goal is < 130/80 mmHg.…”

Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention

“…However, there remain substantial physician- and system-level barriers to the management of hypertension and its complications, given the poor availability of manpower and limited clinical capacity in low-resource primary care settings where multi-component complex interventions are less common ( 21 – 23 ). The barriers are likely exacerbated by the traditional single disease approach ( 24 , 25 ), coupled with “clinical inertia”, i.e., a common failure of physicians to initiate or intensify care regime when indicated ( 26 ), thus leading to difficulties in maintaining satisfactory control of BP and FPG over time ( 27 , 28 ), with increased incidence of cardiovascular events ( 29 ). The hypothesis that multidisciplinary team-based care may overcome “clinical inertia” in the real-world community setting needs to be further tested.…”