Control of blood pressure in a diabetic is important to prevent a number of complications.


Goal for systolic blood pressure: < 130 mm Hg

Goal for systolic blood pressure with overt nephropathy: 120 mm Hg

Goal for diastolic blood pressure: < 80 mm Hg

Goals for pregnant woman with chronic hypertension: 110-129 mm Hg systolic and 65-79 mm Hg diastolic

Blood Pressure

Other Factor


systolic 130-139


lifestyle modification for 3 months; if not controlled, then start ACE inhibitor or ARB

systolic >= 140


ACE inhibitor or ARB initially plus lifestyle modification

systolic >= 130


lifestyle modification; calcium channel blocker (nifedipine) or thiazide diuretic or beta-blocker; ACE inhibitor or ARB contraindicated

failure to reach goals on initial therapy

GFR >= 50 mL per min per 1.73 sq m

add a thiazide diuretic

failure to reach goals on initial therapy

GFR < 50 mL per min per 1.73 sq m

add a loop diuretic


Additional management:

(1) An elevated blood pressure reading should be confirmed on a separate day before action is taken.

(2) Monitor serum potassium and creatinine if receiving pharmacologic therapy.

(3) A beta-blocker should be added if the patient has a history of cardiovascular disease. A specific beta-1 antagonist is recommended since there it is less likely to mask hypoglycemia or cause hyperkalemia.

(4) Orthostatic hypotension may be a problem, especially with nephropathy, autonomic neuropathy or aggressive pharmacologic management.


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