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Hypertension: Management In Adults With Diabetes
Hypertension: Management In Adults With Diabetes -- Posted by Gumbo on 10-23-04 05:55
Hypertension: Management In Adults With Diabetes
Originally Published:20041001.
The American Diabetes Association regularly develops and updates guidelines
for doctors for treating diabetes. Each month, one of these clinical
practice guidelines will be discussed, to provide you with an inside look at
all the latest ADA recommendations.
"Hypertension Management In Adults With Diabetes" gives ADA's
recommendations on controlling high blood pressure (hypertension) in adults
who have diabetes but are not pregnant.
Background. High blood pressure is a common problem in people with diabetes.
Researchers believe that 20 percent to 60 percent of people with diabetes
have a blood pressure of 140/90 mmHg or higher. (The newest government
guidelines define high blood pressure as a blood pressure of 120/80 mmHg or
higher.)
High blood pressure is a serious matter. It increases the risk of heart
attack and stroke, as well as diabetes complications such as diabetic eye
disease and diabetic kidney disease.
People can reduce these risks by taking steps to lower their blood pressure.
Lifestyle changes for reducing blood pressure include:
* Losing weight
* Reducing the amount of salt in the diet
* Eating a diet rich in fruits, vegetables, and low-fat dairy products
* Eating a diet low in saturated and total fat
* Not using tobacco
* Drinking alcohol only in moderation
* Exercising moderately (for example, 30 to 45 minutes of brisk walking on
most days of the week).
Also, several kinds of drugs can lower blood pressure.
Recommendations. ADA recommends that doctors measure blood pressure at every
routine diabetes visit. When a person has a systolic blood pressure (the top
number) of 130 mmHg or above or a diastolic blood pressure (the bottom
number) of 80 mmHg or above, he or she should come back on another day to
have blood pressure measured again. People should also have their blood
pressure measured while standing up if there are reasons for the doctor to
suspect diabetic nerve disease of the autonomic nerves (the nerves that
control involuntary actions such as the beating of the heart).
ADA recommends that systolic blood pressure in people with diabetes be less
than 130 mmHg and diastolic blood pressure be less than 80 mmHg.
ADA advises that people who have a confirmed systolic blood pressure of 130
to 139 mmHg or a confirmed diastolic blood pressure of 80 to 89 mmHg should
try lifestyle changes for three months. If these don't bring blood pressure
below 130/80 mmHg, then a drug should be added-either an
angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor
blocker (ARB). (These two drugs are the first choices because they can also
slow the development and progression of diabetic kidney disease.)
People who have a systolic blood pressure of at least 140 mmHg or a
diastolic blood pressure of at least 90 mmHg should start both lifestyle
changes and a drug. The best drugs to start with are ACE inhibitors, ARBs,
beta-blockers, diuretics, and/or calcium channel blockers. These drugs have
all been shown to reduce heart and blood vessel problems in people with
diabetes.
Most people with diabetes and high blood pressure need to take two, three,
or more drugs to get their blood pressure below 130/80 mmHg. One of these
drugs should be an ACE inhibitor or an ARB. These drugs require regular
monitoring of kidney function and plasma potassium levels.
Blood pressure should be lowered slowly in elderly people.
If a person has significant kidney disease or cannot achieve a blood
pressure below 130/80 mmHg when taking three drugs, the health care provider
should refer her or him to a doctor experienced in the care of people with
high blood pressure.
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