Hypertension in people with type 2 diabetes: Update on pharmacologic management.
Can Fam Physician. 2011 Sep;57(9):997-1002
Authors: Campbell NR, Gilbert RE, Leiter LA, Larochelle P, Tobe S, Chockalingam A, Ward R, Morris D, Tsuyuki RT, Harris SB
Objective To summarize the evidence for the need to improve pharmacologic management of hypertension in people with type 2 diabetes and to provide expert advice on how blood pressure (BP) treatment can be improved in primary care. Sources of information Studies were obtained by performing a systematic review of the literature on hypertension and diabetes, from which management recommendations were developed, reviewed, and voted on by a group of experts selected by the Canadian Hypertension Education Program and the Canadian Diabetes Association; authors' expert opinions on optimal pharmacologic management were also considered during this process. Main message The pathogenesis of hypertension in patients with diabetes is complex, involving a range of biological and environmental factors and genetic predisposition; as a result, hypertension in people with diabetes incurs higher associated risks and adverse events. Mortality and morbidity are heightened in diabetes patients who do not achieve BP control (ie, a target value of less than 130/80 mm Hg). Large randomized controlled trials and meta-analyses of randomized controlled trials have shown that reducing BP pharmacologically is single-handedly the most effective way to reduce rates of death and disability in patients with diabetes, particularly associated cardiovascular risks. Often, combinations of 2 or more drugs (diuretics, angiotensin-converting enzyme inhibitors, ?-blockers, angiotensin receptor blockers, calcium channel blockers, spironolactone, etc) are required for pharmacotherapy to be effective, particularly for patients in whom BP is difficult to control. However, the health care costs associated with extensively lowering BP are substantially less than the costs associated with treating the complications that can be prevented by lowering BP. Conclusion Detecting and managing hypertension in people with diabetes is one of the most effective measures to prevent adverse events, and pharmacotherapy is one of the most effective ways to maintain target BP levels in primary care.
PMID: 21918140 [PubMed - in process]