What are the treatment guidelines for hypertension (high blood pressure) in patients with diabetes?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

For patients aged 18 years or older with diabetes, the 2013 Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure ("JNC 8") recommends initiating treatment at systolic blood pressure (SBP) levels of 140 mm Hg or greater or at diastolic BP (DBP) levels of 90 mm Hg or greater, and then treat to a goal BP below 140/90 mm Hg. [88, 89]

The JNC 7 and the 2016 American Diabetes Association (ADA) standard of medical care recommended blood pressure control in diabetic individuals be controlled to 130/80 mm Hg or lower, primarily to prevent or lower the risk of progression from diabetic nephropathy to end-stage renal disease. [5, 71]

This notion is being challenged by data from the ACCORD trial, which showed that in patients with type 2 diabetes, targeting an SBP of less than 120 mm Hg compared with less than 140 mm Hg did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events. [90] A total of 4733 patients with type 2 diabetes were randomly assigned to intensive therapy or standard therapy, with a mean SBP of 119.3 mm Hg in the intensive group and 133.5 mm Hg in the standard group. No difference was observed in terms of primary outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) and no difference was noted in annual rates of death from any cause.

However, annual rates of stroke, a prespecified secondary outcome, were significantly reduced in the intensive therapy group (0.32% vs 0.53%). Serious adverse events attributed to antihypertensive treatment was significantly greater in the intensive therapy group (3.3% vs 1.3%). Thus, other than a minor decrease in stroke rate, intensive BP control in diabetes did not improve outcome and was associated with a greater rate of serious adverse events.


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