Hypertension and Blood Pressure Control in Diabetics
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2016 ADA Guideline Recommendations |
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Types of Diabetes Mellitus |
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2016 ADA Standard of Medical Care Guideline Recommendations |
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Cardiovascular Disease and Risk Management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4] Nehal Eid, M.D.[5]
2025 ADA Standards of Medical Care in Diabetes Guidelines[1][edit | edit source]
SCREENING and DIAGNOSIS[edit | edit source]
| 1. Blood pressure should be measured at every routine clinical visit or at least every 6 months. |
| 2. Hypertension is defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg |
| 3. Blood pressure above the threshold of 120/80 mm Hg predicted an increased risk of coronary heart disease.[2] |
GOALS[edit | edit source]
Systolic and Diastolic Targets[edit | edit source]
| The ADA recommends that persons with diabetes and an office-based blood pressure measurement of 130/80 mm Hg or higher receive pharmacologic therapy to lower blood pressure. (Level of Evidence: A) [3] |
| Individuals with confirmed office-based blood pressure ≥150/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular events in people with diabetes. (Level of Evidence: A) |
Treatment[edit | edit source]
| "1.Patients with blood pressure >120/80 mmHg should be advised on lifestyle changes to reduce blood pressure. (Level of Evidence: B)" |
| "2. Patients with confirmed office-based blood pressure >140/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely subsequent titration of pharmacological therapy to achieve blood pressure goals. (Level of Evidence: A)" |
| "3. Recent guidelines from the American College of Cardiology and American Heart Association recommend an SBP goal of <130 mmHg for older adults, including those at high cardiovascular risk, based on strong evidence from randomized controlled trials and meta-analyses showing reduced cardiovascular events and all-cause mortality without a significant increase in serious adverse events. (Level of Evidence: A)" |
| "4. Lifestyle therapy for elevated blood pressure consists of weight loss, if overweight or obese; a Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern includ- ing reducing sodium and increasing potassium intake; moderation of alcohol intake; and increased physical activity. (Level of Evidence: B)" |
| "5. Pharmacotherapy should include agents from a medication class with proven cardiovascular benefits in diabetes: thiazide-like diuretics, dihydropyridine calcium channel blockers, angiotensin–converting enzyme (ACE) inhibitors, or angiotensin receptor blockers. The ADA noted that patients with hypertension and albuminuria (urinary albumin-to-creatinine ratio ≥300 mg/g creatinine) would particularly benefit from RAAS blockade.[1] (Level of Evidence:A)" |
| "6. RAAS blockade is typically first-line therapy for hypertension in people with diabetes and coronary artery disease. (Level of Evidence: A) |
| "7. Multiple-drug therapy is generally required to achieve blood pressure goals. Avoid combinations of ACE inhibitors and ARBs and combinations of ACE inhibitors or ARBs (including ARBs and neprilysin inhibitors) with direct renin inhibitors. (Level of Evidence: A)" |
| "8. If ACE inhibitors, angiotensin receptor blockers, or diuretics are used, serum creatinine/estimated glomerular filtration rate and serum potassium levels should be monitored. (Level of Evidence: E)" |
Special populations: Pregnancy[edit | edit source]
- In pregnant individuals with diabetes and chronic hypertension, a blood pressure threshold of 140/90 mmHg for initiation or titration of therapy is associated with better pregnancy outcomes than reserving treatment for severe hypertension, with no increase in risk of small-for-gestational-age birth weight. (Level of Evidence: A)
- A blood pressure goal of 110-135/85 mmHg is suggested in the interest of reducing the risk for accelerated maternal hypertension. (Level of Evidence: A)
- There are limited data on the optimal lower limit, but therapy should be deintensified for blood pressure <90/60 mmHg. (Level of Evidence: E)
2016 ADA Standards of Medical Care in Diabetes Guidelines[4][edit | edit source]
Blood pressure (systolic goals):
"1. People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg (Level of Evidence: A)"
"2. Lower systolic targets, such as <130 mmHg, may be appropriate for certain indi- viduals with diabetes, such as younger patients, those with albuminuria, and/or those with hypertension and one or more additional atherosclerotic cardiovascular disease risk factors, if they can be achieved without undue treatment burden. (Level of Evidence: C)"
Diastolic goals:
"1. Individuals with diabetes should be treated to a diastolic blood pressure goal of <90 mmHg (Level of Evidence: A)"
"2.Lower diastolic targets, such as <80 mmHg, may be appropriate for certain indi- viduals with diabetes, such as younger patients, those with albuminuria, and/or those with hypertension and one or more additional atherosclerotic cardiovascular disease risk factors, if they can be achieved without undue treatment burden. (Level of Evidence: B)"
Treatment:
| "1.Patients with blood pressure >120/80 mmHg should be advised on lifestyle changes to reduce blood pressure. (Level of Evidence: B)" |
| "2. Patients with confirmed office-based blood pressure >140/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely subsequent titration of pharmacological therapy to achieve blood pressure goals. (Level of Evidence: A)" |
| "3.In older adults, pharmacological therapy to achieve treatment goals of <130/70 mmHg is not recommended; treating to systolic blood pressure <130 mmHg has not been shown to improve cardiovascular outcomes and treating to diastolic blood pressure <70 mmHg has been associated with higher mortality(Level of Evidence: C)" |
| "4. Lifestyle therapy for elevated blood pressure consists of weight loss, if overweight or obese; a Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern includ- ing reducing sodium and increasing potassium intake; moderation of alcohol intake; and increased physical activity. (Level of Evidence: B)" |
| "5.Pharmacological therapy for patients with diabetes and hypertension should comprise a regimen that includes either an ACE inhibitor or an angiotensin receptor blocker but not both. B If one class is not tolerated, the other should be substituted. (Level of Evidence: C)" |
| "6.Multiple-drug therapy (including a thiazide diuretic and ACE inhibitor/ angiotensin receptor blocker, at maximal doses) is generally required to achieve blood pressure targets. Combinations of ACE inhibitors and ARBs should be avoided (Level of Evidence: B)" |
| "7. Multiple-drug therapy is generally required to achieve blood pressure goals. Avoid combinations of ACE inhibitors and ARBs and combinations of ACE inhibitors or ARBs (including ARBs and neprilysin inhibitors) with direct renin inhibitors. (Level of Evidence: A)" |
| "8. If ACE inhibitors, angiotensin receptor blockers, or diuretics are used, serum creatinine/estimated glomerular filtration rate and serum potassium levels should be monitored. (Level of Evidence: E)" |
References[edit | edit source]
- ↑ 1.0 1.1 American Diabetes Association Professional Practice Committee; 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S207–S238. https://doi.org/10.2337/dc25-S010
- ↑ Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018. Diabetes Technol Ther 2019;21: 66-72.
- ↑ ElSayed NA, Aleppo G, Aroda VR, et al. Cardiovascular disease and risk management: standards of care in diabetes— 2023. Diabetes Care 2023; 46: Suppl 1: S158-S190.
- ↑ "care.diabetesjournals.org" (PDF).
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