Blood pressure management

Measure blood pressure at least annually in an adult with type 2 diabetes without previously diagnosed hypertension or renal disease. Offer and reinforce preventive lifestyle advice.
For an adult with type 2 diabetes on antihypertensive drug treatment when diabetes is diagnosed, review blood pressure control and medications used.
Make changes only if there is poor control or if current drug treatment is not appropriate because of microvascular complications or metabolic problems.

Repeat blood pressure measurements within:
1 month if blood pressure is higher than 150/90 mmHg

2 months if blood pressure is higher than 140/80 mmHg

2 months if blood pressure is higher than 130/80 mmHg and there is kidney, eye or cerebrovascular damage.

Provide lifestyle advice (diet and exercise) at the same time.

Add medications if lifestyle advice does not reduce blood pressure to below 140/80 mmHg (below 130/80 mmHg if there is kidney, eye or cerebrovascular damage).
Monitor blood pressure every 1–2 months, and intensify therapy if the person is already on antihypertensive drug treatment, until the blood pressure is consistently below 140/80 mmHg (below 130/80 mmHg if there is kidney, eye or cerebrovascular damage).

First-line antihypertensive drug treatment should be a once?daily, generic angiotensin?converting enzyme (ACE) inhibitor. Exceptions to this are people of African or Caribbean family origin, or women for whom there is a possibility of becoming pregnant.

The first-line antihypertensive drug treatment for a person of African or Caribbean family origin should be an ACE inhibitor plus either a diuretic or a generic calcium?channel blocker.

A calcium-channel blocker should be the first?line antihypertensive drug treatment for a woman for whom, after an informed discussion, it is agreed there is a possibility of her becoming pregnant.

For a person with continuing intolerance to an ACE inhibitor (other than renal deterioration or hyperkalaemia), substitute an angiotensin II?receptor antagonist for the ACE inhibitor.

Do not combine an ACE inhibitor with an angiotensin II?receptor antagonist to treat hypertension.

If the person’s blood pressure is not reduced to the individually agreed target with first?line therapy, add a calcium?channel blocker or a diuretic (usually a thiazide or thiazide?related diuretic). Add the other drug (that is, the calcium?channel blocker or diuretic) if the target is not reached with dual therapy.

If the person’s blood pressure is not reduced to the individually agreed target with triple therapy, add an alpha?blocker, a beta?blocker or a potassium?sparing diuretic (the last with caution if the person is already taking an ACE inhibitor or an angiotensin II?receptor antagonist).

Monitor the blood pressure of a person who has attained and consistently remained at his or her blood pressure target every 4–6 months. Check for possible adverse effects of antihypertensive drug treatment – including the risks from unnecessarily low blood pressure.

G Mohan.