Diabetes & the Heart

Hypertenion

Screening and Diagnosis

Blood pressure should be measured at every routine diabetes visit. Patients found to have systolic blood pressure >130 mmHg or diastolic blood pressure >80 mmHg should have blood pressure confirmed on a separate day.
Orthostatic measurement of blood pressure should be performed to assess for the presence of autonomic neuropathy.

Patients with diabetes should be treated to a diastolic blood pressure <80 mmHg.
Patients with a systolic blood pressure of 130 to 139 mmHg or a diastolic blood pressure of 80 to 89 mmHg should be given lifestyle/behavioral therapy alone for a maximum of 3 months and then, if targets are not achieved, should also be treated pharmacologically.
Patients with hypertension (systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg) should receive drug therapy in addition to lifestyle/behavioral therapy.
Initial drug therapy may be with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, or diuretics. Additional drugs may be chosen from these classes or another drug class.
In hypertensive patients with microalbuminuria, an ACE inhibitor or an ARB should be strongly considered. If one class is not tolerated, the other should be substituted.
In patients over age 55 years, with hypertension or without hypertension but with another cardiovascular risk factor (history of cardiovascular disease, dyslipidemia, microalbuminuria, smoking), an ACE inhibitor (if not contraindicated) should be considered to reduce risk of cardiovascular events.
In patients with a recent myocardial infarction, beta-blockers, in addition, should be considered to reduce mortality.

Patients with diabetes should be treated to a systolic blood pressure <130 mmHg.

In patients with microalbuminuria or overt nephropathy, in whom ACE inhibitors or ARBs are not well tolerated, a non-dihydropyridine calcium channel blocker (DCCB) should be considered.

If ACE inhibitors or ARBs are used, monitor renal function and serum potassium levels.
In elderly hypertensive patients, blood pressure should be lowered gradually to avoid complications.
Patients not achieving target blood pressure on three drugs, including a diuretic, and patients with severe renal disease should be referred to a specialist experienced in the care of patients with hypertension.