China is a large country with hypertension and diabetes, and with the economic development and aging in China, the incidence of hypertension and diabetes is increasing year by year, and hypertensive patients often have glucose metabolism abnormalities and the occurrence of diabetes. Diabetes mellitus is a group of metabolic diseases characterized by elevated blood glucose. It is mainly caused by defective insulin secretion or impaired biological action, or both. The long-term presence of hyperglycemia in diabetic patients can lead to chronic damage and dysfunction of various tissues, especially the eyes, kidneys, heart, blood vessels, and nerves. Some data show that the prevalence of diabetes in people with hypertension is on average 18%. Hypertension is also an important risk factor for cardiovascular and microvascular complications of diabetes. Once diabetes is combined with hypertension, it not only increases the risk of cardiovascular and cerebrovascular accidents, but also increases the risk of myocardial infarction, cerebrovascular accidents and end-stage macrovascular disease, and accelerates the occurrence and development of retinopathy and nephropathy, which increases the risk of death by 7.2 times. What is the best way to treat hypertension in combination with diabetes?
In this article, we will explain the latest hypertension management guidelines. The latest hypertension management guidelines recommend that the BP target for diabetic patients should be <130/80 mmHg. For elderly patients or patients with severe coronary artery disease, a more lenient BP target of 140/90 mmHg is recommended.
Patients with a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89
Patients with diabetes mellitus can undergo non-pharmacological treatment (mainly including lifestyle improvement, exercise, weight reduction, etc.) for no more than 3 months; if blood pressure cannot reach the target, pharmacological treatment should be used. Blood pressure ≥140/90
mmHg, drug therapy should be started immediately on the basis of non-pharmacological treatment; patients with microalbuminuria should be treated with drugs immediately. Second, the best drug selection and application of hypertension combined with diabetes First, consider using ACEI or ARB. if the combination of drugs is needed, ACEI or ARB should be used as the basis, plus diuretics, dihydropyridine CCB, combined with angina pectoris can be added with beta-blockers. Blood pressure attainment usually requires a combination of 2 or more drugs. Diuretics are used with caution in diabetes combined with hyperuricemia. For recurrent hypoglycemia, use β-blockers with caution as they may mask the symptoms of hypoglycemia. When diuretics and beta-blockers are needed, it is advisable to start with small doses. If a male patient has an enlarged prostate and poorly controlled blood pressure, alpha-blockers may be used.