Evidence-based approach for managing hypertension in type 2 diabetes

Review

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Authors: Gerti Tashko, Robert A Gabbay

Published Date May 2010 Volume 2010:3 Pages 31 - 43

DOI: http://dx.doi.org/10.2147/IBPC.S6984

Gerti Tashko¹, Robert A Gabbay²

¹Division of Endocrinology, Diabetes, and Metabolism, Penn State College of Medicine, Hershey, PA, USA; ²Penn State Institute for Diabetes and Obesity, Penn State College of Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA, USA

Abstract: Blood pressure (BP) control is a critical part of managing patients with type 2 diabetes. Perhaps it is the single most important aspect of diabetes care, which unlike hyperglycemia and dyslipidemia can reduce both micro- and macrovascular complications. Hypertension is more prevalent in individuals with diabetes than general population, and in most cases its treatment requires two or more pharmacological agents (about 30% of individuals with diabetes need 3 or more medications to control BP). In this article we describe the key evidence that has contributed to our understanding that reduced BP translates into positive micro- and macrovascular outcomes. We review the data supporting current recommendation for BP target < 130/80 mmHg. Two studies suggest that a lower BP goal could be even more beneficial. We also present the comparative benefits of various antihypertensive drugs in reducing diabetes-related micro- and macrovascular complications. Finally we propose an evidence-based algorithm of how to initiate and titrate antihypertensive pharmacotherapy in affected individuals. Overall, achieving BP < 130/80 mmHg is more important than searching for the “best” antihypertensive agent in patients with diabetes.

Keywords: blood pressure control, treatment protocol, fixed dose combination, clinical inertia, adherence

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