A 44-year-old Caucasian male with a 1-year history of type 2 diabetes comes to the clinic for follow-up. Recent laboratory findings include an A1c level of 6.9%. Vitals include a blood pressure of 146/84 mm Hg. The patient wants to know his blood pressure goal.
Hypertension is a common comorbidity of diabetes, and both conditions are considered major risk factors for the development of cardiovascular and microvascular complications. Patients with both conditions are at about twice the risk for cardiovascular disease.
Lowering blood pressure in patients with diabetes clearly has a benefit in reducing renal complications, cardiovascular events, and death. Because hypertension occurs in the majority of patients with diabetes, lowering patients’ blood pressure is vital to their care. Understanding the goals for the management of hypertension in patients with diabetes is an important first step.
Current guidelines recommend that systolic blood pressure be managed to a goal of lower than 140 mm Hg. The goal for diastolic blood pressure is less clear.
Because evidence clearly shows that lowering blood pressure in patients with diabetes can decrease both cardiovascular and microvascular outcomes, clinicians should place a priority on identifying patients with elevated blood pressure and treating these patients.
Case provided by Bradley M. Wright, PharmD, BCPS