From the Guidelines
Screening for diabetes mellitus (DM) in patients with newly diagnosed hypertension is crucial because the presence of both conditions significantly increases cardiovascular risk and influences treatment decisions. When a patient presents with hypertension, checking for diabetes is important because these conditions frequently coexist and share pathophysiological mechanisms 1. The screening typically involves measuring fasting blood glucose, hemoglobin A1c, or performing an oral glucose tolerance test.
Key Considerations
- Specific targets for blood pressure control are more stringent in diabetic patients, with a recommended systolic blood pressure (SBP) goal of <130 mmHg and a diastolic blood pressure (DBP) target of <80 mmHg 1.
- Certain antihypertensive medications like ACE inhibitors (e.g., lisinopril 10-40 mg daily) or angiotensin receptor blockers (e.g., losartan 50-100 mg daily) are preferred first-line agents in diabetic patients because they provide renoprotective effects beyond blood pressure control 1.
- The underlying connection between these conditions involves insulin resistance, which contributes to both hypertension through sodium retention and sympathetic nervous system activation, and to diabetes through impaired glucose metabolism.
Management Approach
- Early detection of diabetes in hypertensive patients allows for comprehensive risk management and may prevent complications affecting the heart, kidneys, eyes, and nervous system.
- Lifestyle modification is central to prevention and management of both DM and hypertension, with an emphasis on weight loss and physical activity for prevention and control of DM 1.
- Addition of antihypertensive drug therapy is recommended because most patients with the combination of hypertension and DM are at high risk for ASCVD 1.
From the Research
Screening for Diabetes in Hypertension
- Screening for diabetes in patients with new hypertension is crucial due to the high prevalence of diabetes in hypertensive patients 2, 3.
- The co-existence of hypertension and diabetes increases the risk of cardiovascular disease, making early detection and management essential 3.
- Studies have shown that screening for diabetes using fasting plasma glucose and hemoglobin A1C can help identify patients with prediabetes and diabetes, allowing for early intervention and prevention of complications 4, 5.
Rationale for Screening
- Hypertension is a major risk factor for cardiovascular disease, and the presence of diabetes further increases this risk 2, 3.
- Early detection and management of diabetes can help prevent or delay the onset of cardiovascular complications 4, 6.
- Cost-effective screening methods, such as the combination of fasting plasma glucose and hemoglobin A1C, can help identify patients with diabetes and prediabetes 5.
Recommendations for Screening
- The American Diabetes Association and the US Preventive Services Task Force recommend opportunistic screening for diabetes in high-risk individuals, including those with hypertension 4, 6.
- Screening should be performed using fasting plasma glucose and hemoglobin A1C, with a goal of identifying patients with prediabetes and diabetes 4, 5.
- Patients with hypertension should be screened for diabetes regularly, with the frequency of screening depending on individual risk factors and medical history 2, 3.