US hypertension in diabetes position statement released

By Editor
25th August 2017
Care planning

A position statement based on hypertension and diabetes has been released in the US.

The document, which was last updated in 2003, was written by nine leading diabetes experts on behalf of the American Diabetes Association (ADA).

The update incorporates findings from recent, noteworthy BP trials, including ACCORD, ADVANCE, SPRINTT and the Hypertension Optimal Treatment (HOT) trial. A newly added pictorial algorithm for the treatment of confirmed hypertension in people with diabetes has also been included.

Speaking to Endocrine Today, George Bakris, professor of medicine and director of the American Society of Hypertension (ASH) and the Comprehensive Hypertension Center at University of Chicago Medicine and a co-author of the statement, said: “There are a number of new findings in this position paper. There is a recommendation to check standing BP on initial visits among people with diabetes to assess both autonomic function as well as potential volume depletion.

“While there is a strong position for a BP of less than 140/90 mm Hg, there is a clear recommendation for a BP of less than 130/80 mm Hg once the patient understands they are at high CV risk.”

Subsequent analyses from a long-term follow-up of ACCORD (ACCORDIAN) and multiple meta-analyses in thousands of patients suggest that a BP of less than 140 mm Hg clearly shows a significant reduction in CVD events and a slowed progression of nephropathy.

Professor Bakris aded: “Those who achieve a BP of less than 130 mm Hg show a further, albeit smaller, reduction in CVD events, but not renal events.”

Lifestyle management plans for lowering BP have also been highlighted in the guideline and include suggestions on weight loss, nutrition and increased physical activity. The statement also details the recommended approach for the use of medication in the treatment of hypertension in people with diabetes, which depends on initial BP, kidney health, response to treatment and adverse effects.

The statement emphasises that women with pre-existing hypertension or mild gestational hypertension (BP < 160/105 mm Hg) and no evidence of end-organ damage should not be treated with antihypertensive medications, as there is no benefit that clearly outweighs the potential risks, the authors noted. BP targets and potential medication guidelines are also included for pregnant patients with diabetes who do require treatment for hypertension.

The statement also noted that there is little evidence that BP medication improves health outcomes in patients with diabetes but without hypertension.

Dr William T. Cefalu, chief scientific, medical and mission officer for the ADA, said: “In the past two decades, we have seen a decrease in [atherosclerotic] CVD morbidity and mortality in people with diabetes, and evidence indicates that advances in blood pressure control are likely the key to such improvements.

“As medical and pharmacological developments occur, it is imperative that medical providers, diabetes educators and patients stay abreast of the most current care recommendations that can lead to improved cardiovascular health for people with diabetes and will ultimately result in better overall health and fewer diabetes-related complications.”

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