What is the best blood pressure medication for diabetics?
There is no single best medication for high blood pressure in diabetes, but some medications are safer than others for certain groups of people with diabetes. In some cases, more than one medication is needed.
Current guidelines from the American Diabetes Association (ADA) recommend that anyone with diabetes and a blood pressure of 140/90 mmHg or higher but less than 160/100 should be started on one blood pressure medication. There are several options for this medication for people with diabetes (without the presence of kidney disease), including drugs called:
- ACE inhibitors (ACEi)
- Angiotensin receptor blockers (ARB)
- Thiazide-like diuretics
- Calcium channel blockers (CCB)
The ADA recommends that people with diabetes and kidney disease in this blood pressure category stick to either ACE inhibitors or ARBs.
If someone with diabetes has a blood pressure of 160/100 or higher, any two blood pressure medications may be started from these three groupings of drugs:
- ACEi or ARB
- Thiazide diuretic
- CCB
The ADA recommends that people with kidney disease in this blood pressure category take an ACEi or ARB, plus either a diuretic or CCB.
If blood pressure is still hard to manage, a third drug from the list may be added.
The goal of blood pressure treatment is to bring your blood pressure down. How much depends on your risk of cardiovascular disease (CVD). If your doctor feels that the risk is high, the blood pressure target may be 130/80. For patients at lower CVD risk, the target may be 140/90.
No matter what drugs are used, lifestyle changes are an important part of treatment. These changes include:
- Weight loss
- Low-salt diet
- Limited alcohol
- Increased physical activity
High blood pressure is common in people with type 2 diabetes. Diabetes does not cause high blood pressure and high blood pressure does not cause diabetes, but they often occur together. This is called comorbidity.
Studies show that about two-thirds of people with diabetes have high blood pressure. Diabetes is a risk factor for heart and blood vessel disease. Having both diabetes and high blood pressure increases your risk of CVD, heart disease and stroke. So, it is important to treat high blood pressure in people with diabetes to lower CVD risk.
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References
- American Diabetes Association (ADA). 2020 ADA Guidelines: Blood Pressure care in Adults With Diabetes. August 2020. Available at: https://www.gertitashkomd.com/blog/2020/4/13/2020-ada-guidelines-blood-pressure-care-in-adults-with-diabetes. [Accessed December 14, 2021].
- American Diabetes Association (ADA). Hypertension Management in Diabetes: 2018 Update. August 2018. Available at: https://spectrum.diabetesjournals.org/content/31/3/218. [Accessed December 14, 2021].
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