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 |
Therapy |
|
systolic 130-139 |
nonpregnant |
lifestyle modification for 3 months; if not controlled, then start ACE inhibitor or ARB |
|
systolic >= 140 |
nonpregnant |
ACE inhibitor or ARB initially plus lifestyle modification |
|
systolic >= 130 |
pregnant |
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.
Purpose: To evaluate the blood pressure of a patient with diabetes.
Specialty: Cardiology
Objective: physical and lifestyle, comorbid conditions, quality of life, prevention
ICD-10: I10, I11, I12, E10-E14,
