From the Guidelines
For a patient with Diabetes Mellitus (DM) and new-onset Stage 2 Hypertension, an ACE inhibitor or ARB should be started as the initial medication.
Rationale
- The patient has Stage 2 Hypertension, which requires prompt initiation and timely titration of pharmacologic therapy to achieve blood pressure goals 1.
- ACE inhibitors or ARBs are recommended as first-line therapy for hypertension in patients with diabetes, especially those with established coronary artery disease or albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) 1.
- These medication classes have been demonstrated to reduce cardiovascular events in patients with diabetes 1.
- Other options, such as thiazide-like diuretics or dihydropyridine calcium channel blockers, may be considered if ACE inhibitors or ARBs are not tolerated 1.
- Multiple-drug therapy may be required to achieve blood pressure targets, but combinations of ACE inhibitors and ARBs should be avoided 1.
- It is essential to monitor serum creatinine/estimated glomerular filtration rate and serum potassium levels at least annually in patients treated with ACE inhibitors, ARBs, or diuretics 1.
From the Research
Medication for Diabetes Mellitus (DM) and New-Onset Stage 2 Hypertension
The management of hypertension in patients with diabetes mellitus is crucial to reduce the risk of cardiovascular disease. According to various studies 2, 3, 4, 5, the goal of blood pressure management in diabetic patients should be below 140/90 mmHg, with some studies suggesting a target of 130-135/85 mmHg 4 or less than 130/80 mmHg 3.
Recommended Medications
- A renin-angiotensin system blocker combined with a calcium channel blocker may be a suitable first-line treatment for patients with diabetes and hypertension 4.
- A combination of a renin-angiotensin system blocker and a thiazide-type diuretic might be the best initial antihypertensive regimen for most people with diabetes 5.
- Calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers have been reported to be either neutral or beneficial with regard to the overall metabolic risk factor profile in diabetic patients 3.
Key Considerations
- Aggressive control of blood pressure, cholesterol, and glucose levels should be attempted to reduce the cardiovascular risk of diabetic hypertensive patients 3.
- Combination therapy is usually required to achieve blood pressure goals in diabetic patients 3.
- The presence of chronic kidney disease (CKD) should be considered when managing hypertension in patients with diabetes mellitus 2.