Controlling Hypertension in Diabetic Patients

Abstract

Hypertension is the commonest non-communicable disease in Nigeria and an important risk factor for both macrovascular and microvascular complications in patients with diabetes. About 60 – 80% of people with Type 2 diabetes mellitus die from cardiovascular diseases and up to 70% of this is attributable to hypertension. Hypertension is common in patients with diabetes occurring in about 22.4% of patients with type 1 and 58.9% of patients with type 2 diabetes mellitus in Nigeria.

This manuscript reviews the current thinking in managing  hypertension in diabetic patients, taking into cognizance results of  recent large scale intervention studies, using as many as search engines available including medline, pubmed, African journal on line amongst others.

The management of patients with diabetes offer additional challenges above the non- diabetic patient. This includes additional cardiovascular risk factors; appropriate glycaemic control and getting blood pressure to target. Combination therapy is required because of the difficulty in getting to target BP, while being careful of choice of drugs because the special metabolic state. Lifestyle modification is paramount.

The target BP, based on results of interventional studies should be systolic 130 – 135 mm Hg and diastolic BP not below 70mm Hg. There are increased risks when systolic BP is higher than 140 mm Hg. Combination therapy which should include initially an RAAS (Renin Angiotensin Aldosterone System) blocker is required. Low dose thiazide diuretic will almost always be required particularly in black patients. Carvedilol has been shown to improve outcome amongst all the Beta- blockers.

Finally, treatment should be individualized and personalized.