Hypertension and Diabetes

Diabetes specialists and hypertension specialists should integrate the 2020 American Diabetes Association guidelines into their clinical practice. These guidelines emphasize achieving specific blood pressure targets for different patient groups. For instance, adults at high risk of ASCVD should aim for BP levels below 130/80 mmHg, while those with gestational diabetes should target below 135/85 mmHg. Individuals with low ASCVD risk should aim for BP levels below 140/90 mmHg. Lifestyle modifications and appropriate medications are key components recommended to achieve these goals, with careful consideration of potential drug side effects.

Dr. Tashko

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2020 ADA Guidelines

For patients with diabetes and hypertension, blood pressure targets should be individualized through a shared decision-making process that addresses cardiovascular risk, potential adverse effects of antihypertensive medications, and patient preferences.

  • For individuals with diabetes and hypertension and at higher cardiovascular risk (defined as an existing ASCVD or 10-year ASCVD risk ≥15%), a BP target of <130/80 mmHg may be appropriate, if it can be safely attained.
  • For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year ASCVD risk <15%), treat to a blood pressure target of <140/90 mmHg.
  • In pregnant patients with diabetes and pre-existing hypertension, a blood pressure target of ≤135/85 mmHg is suggested in the interest of reducing the risk for accelerated maternal hypertension and minimizing impaired fetal growth.
  • For patients with blood pressure >120/80 mmHg, lifestyle intervention consists of
    • Weight loss if overweight or obese,
    • Dietary Approaches to Stop Hypertension (DASH)-style eating pattern including
      • Reducing sodium and
      • Increasing potassium intake
  • Key medications to use are:
    • ACE inhibitors
    • Angiotensin receptor blockers
      • However, combinations of ACE inhibitors and angiotensin receptor blockers and combinations of ACE inhibitors or angiotensin receptor blockers with direct renin inhibitors should not be used.
    • Thiazide-like diuretics
    • Dihydropyridine calcium channel blockers.
Dr. Tashko is an ABIM board-certified endocrinologist with additional certifications in lipidology, hypertension, and obesity medicine. He delivers personalized, holistic care to patients in Montgomery County, Maryland.