Hypertension in people with Type 2 diabetes

Knowledge-based diabetes-specific guidelines

C. Berne, K. Borch-Johnsen, V. Christov, P. Cromme, A. Ericsson, Philip D. Home, R. Landgraf, G. Mancia, P. Senior

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

The International Diabetes Federation (Europe) has updated these guidelines on hypertension management specifically in Type 2 diabetes in the light of recent results of the first prospective, randomized controlled studies to investigate clinical outcomes in people with diabetes and hypertension. The guidelines are knowledge based, i.e. based not only on evidence originating from clinical trials, but also from epidemiological and pathophysiological studies. A successful management strategy requires the following components: 1. Regular surveillance to detect developing hypertension and other cardiovascular (CV) risk factors. 2. Considering more frequent monitoring and review of CV risk factors if any single blood pressure (BP) measurement > 140/85 mmHg (or 130/75 if microalbuminuria); when appropriate, using ambulatory or home monitoring to establish the baseline BP. 3. Considering other CV risk factors, such as a raised albumin excretion rate, in setting the intervention threshold. 4. Individualizing the target BP in accordance with other CV risk factors. 5. Agreeing lifestyle and therapeutic interventions with the patient, with education and empowerment as required. 6. Implementing lifestyle modifications, including controlling calorie, salt and alcohol intake, increased physical activity, weight control and smoking cessation. 7. Therapeutic strategy: the primary goal of therapy is to reduce BP markedly. Combination therapy is often necessary, e.g. an angiotensin converting enzyme (ACE) inhibitor and a diuretic. Some classes are particularly useful for certain patients, notably longer-acting ACE inhibitors, angiotensin 2 receptor antagonists (A2RAs) and calcium antagonists in those at risk of diabetic nephropathy, loop diuretics and thiazides in those at risk of hyperkalaemia, β-blockers and calcium antagonists (except short-acting dihydropyridines) in patients with angina, β-blockers and ACE inhibitors after a myocardial infarction or in those with left ventricular dysfunction, and thiazide diuretics and long-acting dihydropyridine calcium antagonists for isolated systolic hypertension. A2RAs should be particularly considered when ACE inhibitors are not tolerated. α1-Blockers should not be considered first line in the absence of outcome data. Cost of drugs will modify these strategies in developing countries. 8. Monitoring response to therapies and, if target levels are not achieved, either intensifying drug therapy if the CV risk justifies it, or reassessing the target. 9. Maintaining a quality assurance strategy. This strategy is summarized in a simple, practical management algorithm.

Original languageEnglish
Pages (from-to)972-987
Number of pages16
JournalDiabetic Medicine
Volume20
Issue number12
DOIs
Publication statusPublished - Dec 2003

Fingerprint

Type 2 Diabetes Mellitus
Angiotensin-Converting Enzyme Inhibitors
Guidelines
Hypertension
Angiotensin II Type 2 Receptor Blockers
Blood Pressure
Calcium
Life Style
Dihydropyridines
Sodium Potassium Chloride Symporter Inhibitors
Thiazides
Sodium Chloride Symporter Inhibitors
Therapeutics
Patient Participation
Hyperkalemia
Drug Costs
Diabetic Nephropathies
Left Ventricular Dysfunction
Smoking Cessation
Diuretics

Keywords

  • Evaluation
  • Guidelines
  • Hypertension
  • International Diabetes Federation
  • Treatment
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Berne, C., Borch-Johnsen, K., Christov, V., Cromme, P., Ericsson, A., Home, P. D., ... Senior, P. (2003). Hypertension in people with Type 2 diabetes: Knowledge-based diabetes-specific guidelines. Diabetic Medicine, 20(12), 972-987. https://doi.org/10.1046/j.1464-5491.2003.01021.x

Hypertension in people with Type 2 diabetes : Knowledge-based diabetes-specific guidelines. / Berne, C.; Borch-Johnsen, K.; Christov, V.; Cromme, P.; Ericsson, A.; Home, Philip D.; Landgraf, R.; Mancia, G.; Senior, P.

In: Diabetic Medicine, Vol. 20, No. 12, 12.2003, p. 972-987.

Research output: Contribution to journalArticle

Berne, C, Borch-Johnsen, K, Christov, V, Cromme, P, Ericsson, A, Home, PD, Landgraf, R, Mancia, G & Senior, P 2003, 'Hypertension in people with Type 2 diabetes: Knowledge-based diabetes-specific guidelines', Diabetic Medicine, vol. 20, no. 12, pp. 972-987. https://doi.org/10.1046/j.1464-5491.2003.01021.x
Berne C, Borch-Johnsen K, Christov V, Cromme P, Ericsson A, Home PD et al. Hypertension in people with Type 2 diabetes: Knowledge-based diabetes-specific guidelines. Diabetic Medicine. 2003 Dec;20(12):972-987. https://doi.org/10.1046/j.1464-5491.2003.01021.x
Berne, C. ; Borch-Johnsen, K. ; Christov, V. ; Cromme, P. ; Ericsson, A. ; Home, Philip D. ; Landgraf, R. ; Mancia, G. ; Senior, P. / Hypertension in people with Type 2 diabetes : Knowledge-based diabetes-specific guidelines. In: Diabetic Medicine. 2003 ; Vol. 20, No. 12. pp. 972-987.
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