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2017 ; 5
(1
): 84-92
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English Wikipedia
ADDRESSING HYPERTENSION IN THE PATIENT WITH TYPE 2 DIABETES MELLITUS:
PATHOGENESIS, GOALS, AND THERAPEUTIC APPROACH
#MMPMID29129996
Rizvi AA
Eur Med J Diabetes
2017[Oct]; 5
(1
): 84-92
PMID29129996
show ga
Hypertension is considered a powerful cardiovascular risk factor and is present
in up to two-thirds of patients who suffer from diabetes. In the background of an
established epidemiological association between lower blood pressure (BP) and
improvement in long-term clinical outcomes, several large landmark trials and
analyses have attempted to examine the possible benefit of tighter BP control in
patients with Type 2 diabetes mellitus. Although aggressive BP targets in
patients with diabetes have been advocated for a long time, currently accepted
evidence from these studies has led to a general recommendation of systolic BP
<140 mmHg and diastolic BP <90 mmHg. Therapy consists of lifestyle management,
including weight loss if overweight or obese, a Dietary Approaches to Stop
Hypertension (DASH)-style based nutrition counselling, and reduced sodium intake.
Timely initiation and subsequent titration of antihypertensive medications to
achieve individualised BP goals is recommended. A therapeutic agent that acts on
the renin-angiotensin-aldosterone pathway, such as an angiotensin-converting
enzyme inhibitor or an angiotensin receptor blocker, should generally be included
in the pharmacologic therapy for hypertension in patients with Type 2 diabetes
mellitus. A multi-drug combination, particularly including a thiazide diuretic,
is very often necessary and should be started early in the course of management.
Finally, an accurate and standardised method of BP measurement in the outpatient
setting is essential to ensure proper monitoring and gauge the effectiveness of
treatment.