Patients who are both diabetic and hypertensive require a more aggressive and more integrated treatment plan than current guidelines advise, according to a recent position paper from the American Society of Hypertension (ASH).

“We know that mortality increases by more than sevenfold when hypertension is present in patients with diabetes,” explains coauthor George Bakris, MD. “It is imperative that we attack all risk factors simultaneously and manage the profile of each patient type more vigilantly.”

The paper offers a modified algorithm (Figure 1) that addresses BP, glycemic control, hyperlipidemia, and proteinuria.1 It recommends early initiation of medications that block the renin-angiotension system (ACE inhibitors or angiotensin II receptor blockers) coupled with either thiazidelike diuretics or calcium antagonists to maintain BP <130/80 mm Hg. The paper also urges more frequent monitoring combined with follow-up visits two to three weeks after each medication adjustment and immediate referral to a clinical hypertension specialist if repeated attempts to achieve BP goal fail.
Figure 1. Suggested approach to achieve BP goal in patients with diabetes
“Clinicians are not being as aggressive as they need to be in getting the BP under control early in the disease process,” notes Dr. Bakris, ASH president-elect and director of the Hypertensive Diseases Unit at the University of Chicago’s Pritzker School of Medicine. “They’re taking six months, 10 months, a year-plus.”

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Hypertension is the most prevalent risk factor for cardiovascular disease (CVD) and kidney disease. Meanwhile, diabetes is associated with a doubled risk for CVD and is the most common cause of renal failure requiring dialysis. More than 75% of adults with diabetes have hypertension or are using antihypertensive medication. The position paper was designed to update clinicians on the most recent research and to provide guidance in how to implement it.