Hypertension management algorithm for type 2 diabetic patients applied in primary care

Abstract

BackgroundHypertension frequently coexists with type 2 diabetes (DM), and increases the risk of cardiovascular outcomes. The aim of the study was to obtain/maintain blood pressure (BP) goals (ADA/JNC 7) according to a stepwise algorithm using the medication supplied by the Brazilian government.MethodsA one-year, single-arm interventional study conducted with type 2 diabetes patients. Intervention consisted of intensification of lifestyle changes and sequential prescription of drugs: diuretic; ACE inhibitors; β-adrenergic blocking agent and calcium channel blocking agent if BP >130/80 mmHg.ResultsSeventy-eight patients completed the trial. During intervention, the number of antihypertensive tablets rose (3.6 ± 3.5 vs. 5.9 ± 3.5 pills/patient; p <0.001), as the number of antihypertensive classes increased (1.8 ± 1.0 vs. 2.70 ± 1.2; p < 0.01) and the overall drop of BP was 11 mmHg for SBP (145.0 ± 22.8 vs. 133.7 ± 20.9 mmHg; p < 0.01) and 5 mmHg for DBP (78.7 ± 11.5 vs. 73.7 ± 10.5 mmHg; p = 0.001). Although the number of patients with BP in target almost doubled [14 (18.7%) vs. 30 (38.5%) p = 0.008], less than 40% of the patients achieved the proposed goals.ConclusionsA BP algorithm applied to type 2 diabetic and hypertensive patients is able to lower BP, however more than half of the patients did not achieve the ADA/JNC 7 targets demonstrating the complexity of BP control in this population.Trial registrationClinicalTrials.gov: NCT06260

The goal of blood pressure in the hypertensive patient with diabetes is defined: now the challenge is go from recommendations to practice

“…by using combination therapies). A recent study [ 19 ] using a meticulously algorithm applied to DM2 patients was able to lower BP, however more than half of the patients did not achieve the ADA/Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The Seventh Report (JNC 7) targets demonstrating the complexity of BP control in this population.…”

Effects of the DASH Diet and Walking on Blood Pressure in Patients With Type 2 Diabetes and Uncontrolled Hypertension: A Randomized Controlled Trial

“…However, the BP control must be lifelong in order to maintain the reduction of risk for diabetic complications . Generally, hypertensive diabetic patients take three or more antihypertensive drugs and most do not attain the BP goals . In this sense, lifestyle modifications such as diet and physical activity, besides their beneficial influence on glucose control, are key factors in the management of BP in patients with diabetes…”

“…3 Generally, hypertensive diabetic patients take three or more antihypertensive drugs and most do not attain the BP goals. 4 In this sense, lifestyle modifications such as diet and physical activity, besides their beneficial influence on glucose control, 5 are key factors in the management of BP in patients with diabetes. 6 Dietary recommendations for patients with hypertension include reduction of sodium intake, moderation of alcohol consumption, and the adoption of the Dietary Approaches to Stop Hypertension (DASH) diet eating plan.…”

Effects of the 52% low-sodium salt applied to CM-DASH diet in hypertensive patients with type 2 diabetes：A Randomized Controlled Trial

“…Studies have found that about 50% of T2D patients have hypertension, and 20% of hypertensive patients have T2D [7] . Hypertension coexists with T2D, which increases the risk of cardiovascular-related events and makes BP management more complicated and difficult [8] . Drug use alone makes BP control hard to achieve, so lifestyle intervention (such as dietary intervention and exercise) is more needed.…”