This concise summary outlines the 2020 American Diabetes Association guidelines on managing hypertension in patients with diabetes. The guidelines cover various aspects such as lifestyle modifications, medications, potential side effects of drugs, and recommended blood pressure (BP) targets. The primary goals are to achieve BP levels below 130/80 mmHg for adults at high risk of ASCVD, below 135/85 mmHg for those with gestational diabetes, and below 140/90 mmHg for individuals with low ASCVD risk.
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.