Editor’s Pick: Addressing Hypertension in the Patient with Type 2 Diabetes Mellitus: Pathogenesis, Goals, and Therapeutic Approach
The Editor’s Pick for this issue is an informative review from Ali A. Rizvi on hypertension in patients with Type 2 diabetes mellitus and considers the pathogenesis, goals, and therapeutic approaches to managing this comorbidity. There have been many clinical trials in this area and this paper discusses the outcomes of these trials and the implications for patients with diabetes. Efforts are needed to translate the knowledge already gained into population-based implementation while further research is required to understand the pathogenetic mechanisms and to expand the therapeutic armamentarium. Samantha Warne
*Ali A. Rizvi
Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
*Correspondence to Ali.Rizvi@uscmed.sc.edu
Disclosure: The author has declared no conflicts of interest.
Received: 03.04.17 Accepted: 18.08.17
Citation: EMJ Diabet. 2017;5:84-92.
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.
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