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At the GOODLIFE/SHARING Clinics, you will usually be the one taking the patient’s vital signs. Blood pressure is a very important issue. If the patient checks BPs outside the clinic ask what values they are getting. However, the size of the cuff they use and the timing of the BP may affect the values.  Even if BPs are normal at home and high in clinic, the high BP in clinic should be treated because it suggests that some of the time they are reaching values that can contribute to vascular disease.

Hypertension increases risk of cardiovascular complications (as it does in the general population), as well as retinopathy and nephropathy. 

In the general population, the threshold for treating HTN is 140/90. In the diabetic population, the threshold is 130/80. If the patient is over this threshold, guidelines call for re-measuring on a different day. If this measurement is confirmed, therapy should be started.

For patients with systolic BP of 130-139 OR diastolic BP of 80-89, lifestyle changes can be tried for 3 months before starting drug therapy.

The following are ADA recommendations regarding drug therapy and are included for completeness:

• Any patient with confirmed BP over 140/90 should be on a BP med.
• Most patients require more than one BP med to get their BP under 130/80.
• The initial drug may be any drug proven to reduce cardiovascular events (ACEs, ARBs, beta-blockers, calcium channel blockers, and diuretics), but all patients with diabetes and HTN should be on a regimen that includes either an ACE inhibitor or an ARB. ACE inhibitors are typically the initial drug of choice.
• In patients with type 1 DM and albuminuria (measurable albumin in the urine—a measure of nephropathy), ACEs delay progression of chronic kidney disease (CKD).
• In patients with type 2 DM and albuminuria, ACEs or ARBs delay progression of CKD.
• Patients on ACE, ARBs, or diuretics should have kidney function and potassium levels monitored.

The bottom line for you is this: blood pressure, like glycemic control, affects your patient’s risk for most of the common complications of diabetes.