Hypertension management in type 2 diabetes mellitus: recommendations of the Joint National Committee VII.
HTN in patients who have diabetes should be managed aggressively; the goal BP of less than 130/80 mm Hg should be attained if clinicians seek to reduce cardiovascular morbidity and mortality for these patients. Along with instituting medical therapy after HTN is detected, lifestyle modifications need to be managed aggressively, together with strict glycemic and lipid control. Early management and optimization of treatment of HTN can delay and possibly prevent progression of cardiovascular complications,such as CAD, CKD, peripheral vascular disease, and cerebrovascular disease. Studied approaches to treat HTN in diabetics have included ACEIs and ARBs. Either class of medication, generally in combination with a thiazide diuretic, should be considered as initial therapy. Calcium antagonists, BBs, and alpha-antagonists also have a role in this population of patients, usually as third- and fourth-line add-ons. The importance of using agents that block RAAS is becoming understood better. Typically, three or more antihypertensive medications plus lifestyle interventions are required to achieve a goal BP of less than 130/80 mm Hg. Managing patients who have diabetes and HTN is a dynamic, ever-changing challenge. Early and aggressive antihypertensive therapy pays off;it is hoped that the insights in this article enable clinicians to meet the challenge more successfully.
Whaley-Connell
Adam
A
Department of Internal Medicine, Health Sciences Center, University of Missouri School of Medicine, Columbia, MO 65212, USA.
Sowers
James R
JR
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology
D000959:Antihypertensive Agents