Pharmacologic Management of Hypertension in Patients with Diabetes

  • Whalen K
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Abstract

pproximately 23 . 6 million adults in the United States have diabe - tes . 1 Hypertension is a common comorbidity in these patients ; it is 1 . 5 to three times more common in patients not have the disease . 2 , 3 Heart disease and stroke account for 65 percent of deaths in patients , 4 and a major risk factor for these macrovascular complications . In addition , hypertension markedly complications , such - inopathy . 2 , 3 The U . K . Prospective Diabetes Study (UKPDS) 38 of - cant , macro - vascular , and - related mortality . 5 In the Hypertension Optimal Treatment , patients diastolic (DBP) was 80 mm Hg had a 50 percent reduction in major those . 6 Controlling cardiovascular . It - sive care plan that should include optimal management , aspirin , and . Guideline Recommendations Evidence supports aggressive blood pressure targets in patients with diabetes . Consensus guidelines - tee , Detection , Evaluation , and Treatment of High Blood Pressure 7 ; the American (ADA) 8 ; and the (NKF) 9 rec - ommend a blood pressure goal of less than 130 / 80 . The ADA measured . 2 , 8 Patients with between between a - month (Table 1 2 , 7 , 10) . 7 , 8 Patients who do not achieve a / 80 with , and Hypertension is a common comorbidity in patients with diabetes , and adequate control of blood pressure significantly reduces the risk of macrovascular and microvascular complica - tions . Patients with diabetes should achieve a target blood pressure of less than 130 / 80 mm Hg . The use of angiotensin - converting enzyme inhibitors may slow progression to kidney failure and cardiovascular mortality ; these agents are the preferred therapy for managing coexisting diabetes and hypertension . Angiotensin receptor blockers can prevent progression of diabetic kidney disease and are a first - line alternative for patients intolerant of angiotensin - converting enzyme inhibitors . Thiazide diuretics provide additional antihypertensive effects when com - bined with angiotensin - converting enzyme inhibitors or angiotensin receptor blockers . With lower doses of these drugs , the risk of clinically significant metabolic alterations is minimal . Beta blockers and calcium channel blockers also have beneficial effects in managing hyperten - sion in patients with diabetes . Beta blockers reduce cardiovascular events and are useful in a multidrug regimen . Dihydropyridine calcium channel blockers should be reserved for patients intolerant of preferred agents or those who need additional therapy to achieve target blood pressure . Many patients with diabetes require combination therapy with multiple antihyper - tensive agents . (Am Fam Physician . 2008 ; 78 (11) : 1277 - 1282 . www . aafp . org / afp Volume 78 , Number 11 ◆ December 1 , 2008 blood / 90 , should treated . Because that increase , blood be . Lowering Hg is not recommended , particularly in patients with coexisting (CAD) . 7 , 11 Pharmacologic Therapy ACE INHIBITORS Angiotensin - converting enzyme (ACE) inhibitors pre - vent or delay microvascular and macrovascular com - plications - line antihypertensive agents in patients with diabetes . 2 , 8 , 9 ACE inhibitors delay progression of diabetic kidney disease 7 - 9 and medications failure (i . e . , glomerular [ GFR ] of less than 15 mL per min per 1 . 73 m 2 or need) in - tension - minuria . 9 The Heart Outcomes Prevention Evaluation trial randomized patients with diabetes - lar (Altace) daily . 12 Patients group - cause - tality rates (10 . 8 versus 14 . 0 percent ; num - ber [ NNT ] =) and risk myocardial (MI) , stroke , or cardiovascular (15 . 3 . 8 - cent ; NNT) . A use of ACE inhibitors in patients with dia - betic kidney disease showed that treatment at maximum tolerable dosages was associ - ated of - cause . 13

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  • Karen Whalen

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