XII. Treatment of Hypertension in association with Diabetes Mellitus: Summary
{"Image DocumentName": "XII. Treatment of Hypertension in association with Diabetes Mellitus: Summary", "Image ImageDescription": "Threshold equal or over 130/80 mmHg and TARGET below 130/80 mmHg. with. Nephropathy. A combination of 2 first line drugs may be considered as initial therapy if the blood pressure is >20 mmHg systolic or >10 mmHg diastolic above target. Combining an ACEi and a DHP-CCB is recommended. ACE Inhibitor. or ARB. Diabetes. 1. ACE Inhibitor or ARB. or. 2. DHP-CCB or Thiazide diuretic. without. Nephropathy. > 2-drug combinations. 1. Persons with diabetes mellitus should be treated to attain systolic blood pressure of lower than130 mmHg (Grade C) and diastolic blood pressure of less than 80 mmHg (Grade A). (These target blood pressure levels are the same as the blood pressure treatment thresholds.) Combination therapy using two first-line agents may also be considered as initial treatment of hypertension (Grade B) if the SBP is 20 mmHg above the target or if DBP is 10 mmHg above the target. However caution should be exercised in patients in whom a substantial fall in blood pressure is more likely or poorly tolerated (e.g. elderly patients, patients with autonomic neuropathy). 2. For persons with cardiovascular or kidney disease, including microalbuminuria or with cardiovascular risk factors in addition to diabetes and hypertension, an ACE inhibitor or an ARB is recommended as initial therapy (Grade A). 3. For persons with diabetes and hypertension not included in the above recommendation, appropriate choices include (in alphabetical order): ACE inhibitors (Grade A), angiotensin receptor blockers (Grade B), dihydropyridine CCBs (Grade A) and thiazide/thiazide-like diuretics (Grade A). 4. If target blood pressures are not achieved with standard-dose monotherapy, additional antihypertensive therapy should be used. For persons in whom combination therapy with an ACE inhibitor is being considered, a dihydropyridine CCB is preferable to hydrochlorothiazide (Grade A). Monitor serum potassium and creatinine carefully in patients with CKD prescribed an ACEI or ARB. Combinations of an ACEI with an ARB are specifically not recommended in the absence of proteinuria. More than 3 drugs may be needed to reach target values for diabetic patients. If Creatinine over 150 \u00b5mol/L or creatinine clearance below 30 ml/min ( 0.5 ml/sec), a loop diuretic should be substituted for a thiazide diuretic if control of volume is desired. 66.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}