The management of hypertension in people with diabetes is of the utmost importance to reduce the risk of cardiovascular disease and diabetes complications. The recommended blood pressure target is less than 130/80 mm Hg and aggressive treatment is required to achieve and maintain this target level for most people.
A meta analysis reviewing randomized controlled trials of the effects of pressure lowering regimens in people with and without diabetes showed that lowering blood pressure by 6/4.6 mm Hg reduced total mortality by 27% and major cardiovascular events by 25%.2 The UKPDS study showed that a reduction in blood pressure from 154/82 mm Hg to 144/82 mm Hg resulted in a risk reduction of 24% in diabetes related end points, 32% in death related to diabetes, 37% in microvascular end points and 44% in strokes.
The majority of people with diabetes have hypertension4. In a recent study, two thirds of the people with comorbidities of diabetes and hypertension had uncontrolled blood pressure.5 A recent audit of a small number of patients’ charts in family practice settings in St. John’s NF showed that only 20.6% of people with diabetes were at the recommended target for blood pressure even though physicians knew the target.
About 65 to 80% of people with diabetes will die from cardiovascular events.7 Up to seventy-five percent of cardiovascular complications have been attributed to hypertension. Hypertension is also a major factor contributing to retinopathy and nephropathy.
The management of hypertension includes both lifestyle factors and for many people, pharmacotherapy and these should be implemented concurrently. Lifestyle changes can have some effect in lowering blood pressure but there should be no delay in commencing pharmacotherapy if blood pressure is over 130/80 mm Hg. Many people with diabetes and hypertension require three or more medications to achieve and maintain target BP levels. Achieving and maintaining blood pressure below 130/80 mm Hg can delay myocardial infarctions or strokes making it possible for people to enjoy more years of a full active life.
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Diabetes and Hypertension
