In April 2014, I wrote a blog regarding blood pressure control in patients with diabetes. At the time, the Joint National Committee (JNC) VIII guidelines were new and there were several questions regarding “What is the desired blood pressure goal for a patient with diabetes?” At the time I wrote the blog, the three main guidelines for blood pressure control had the following recommendations:
- 2007: American Heart Association (AHA) – desired blood pressure (BP) goal for a patient with diabetes less than 130/80 mm Hg;
- 2013: JNC-VIII – desired BP goal for a patient with diabetes less than 140/90 mm Hg for a patient with diabetes;
- 2014: American Diabetes Association (ADA) – desired BP goal for a patient with diabetes, less than 140/90 mm Hg or less than 130/80 mm Hg for a younger individual to prevent stroke.
Recently, the American College of Cardiology (ACC) and AHA published clinical guidelines on the diagnosis and treatment of hypertension. Since the publication hit the internet, there has been buzz on the summary and recommendations through list-serves, clinical practice, clinical meetings, and professional meetings.
Here is a summary of the key points from the clinical practice document:
- Stages of hypertension
- Normal: less than 120/80 mm Hg
- Elevated (formerly prehypertension): 120-129/< 80 mm Hg
- Stage 1: 130-139/80-89 mm Hg
- Stage 2: greater than 140/90 mm Hg
- Treatment approach
- Normal: lifestyle modifications with reassessment in one year
- Elevated: lifestyle modifications with reassessment in three to six months
- Stage 1: depends on atherosclerotic cardiovascular disease (ASCVD) assessment – less than 10%, same approach as elevated category; above 10%, lifestyle modifications plus antihypertensive therapy with reassessment in one year
- Stage 2: lifestyle modifications plus antihypertensive therapy with reassessment in one year
What blood pressure goals do you like to achieve in your patients with diabetes?
- Pharmacological options
- First-line therapy: thiazide diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers
- Stage 1: one antihypertensive agent, as initial therapy
- Stage 2: two antihypertensive agents, as initial therapy
- Blood pressure goals
- General: less than 130/80 mm Hg
- Exceptions: less than 140/90 mm Hg for patients with no clinical cardiovascular disease, ASCVD risk less than 10%, history of stroke (i.e., secondary prevention)
As the saying goes – “Times, they are a changing,” or “Out with the old and in with the new.” It is important to remain up-to-date with literature and new guidelines. However, the ADA guidelines will be published before the holidays, so we can also refer to the Standards of Medical Care regarding the recommended BP goal from this organization.
Were you aware of the latest publication on hypertension management?
Let’s discuss these recommendations:
- What are your thoughts regarding these recommendations?
- What blood pressure goals do you like to achieve in your patients with diabetes?
- Does this goal vary depending on the age of the patient?
About the Author
Jennifer Clements received her Doctorate of Pharmacy from Campbell University in 2006 and completed a primary care residency at a Veterans Affairs Medical Center in 2007. She is also a certified diabetes educator and board certified in pharmacotherapy. Currently, she is an Associate Professor of Pharmacy Practice at Presbyterian College School of Pharmacy.