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
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
GFR < 50 mL per min per 1.73 sq m
add a loop diuretic
(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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Purpose: To evaluate the blood pressure of a patient with diabetes.
Objective: physical and lifestyle, comorbid conditions, quality of life, prevention
ICD-10: I10, I11, I12, E10-E14,