SUMMARY OF INTENSIVE MANAGEMENT OF TYPE 1 DIABETES: SPECIAL ISSUES – HYPERTENSION

An elevation of blood pressure to >130/80 mmHg usually occurs in type 1 diabetes just before or at the time of development of microalbuminuria. At the stage of clinical albuminuria (urinary albumin > 300 mg/day), the majority of people with type 1 diabetes have BP levels > 130/80 mmHg. Aggressive therapy for hypertension should start at 130/80 mmHg to prevent progression of retinopathy, nephropathy, and cardiovascular events. As the duration of hypertension in type 1 diabetes lengthens, there is usually a need for more than one antihypertensive agent to maintain BP at the level of < 130/80 mmHg. Many specialists prefer to start with a low dose of an ACE inhibitor or angiotensin receptor blocker; add a low dose of a thiazide; add a low dose of a calcium channel blocker; and finally, add a low dose of a cardiospecific beta blocker. If this regimen does not bring BP to the goal of therapy, doses of each agent are then raised in a stepwise fashion until goal of < 130/80 mmHg is reached.

There are many variations on this scheme. Whatever approach is used, the evidence is strong that ACE inhibitor and/or ARB therapy must be used and that persistent adjustments are often necessary to achieve BP goals in type 1 diabetic patients with nephropathy and hypertension.

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SUMMARY OF INTENSIVE MANAGEMENT OF TYPE 1 DIABETES: SPECIAL ISSUES – HYPERTENSIONAn elevation of blood pressure to >130/80 mmHg usually occurs in type 1 diabetes just before or at the time of development of microalbuminuria. At the stage of clinical albuminuria (urinary albumin > 300 mg/day), the majority of people with type 1 diabetes have BP levels > 130/80 mmHg. Aggressive therapy for hypertension should start at 130/80 mmHg to prevent progression of retinopathy, nephropathy, and cardiovascular events. As the duration of hypertension in type 1 diabetes lengthens, there is usually a need for more than one antihypertensive agent to maintain BP at the level of < 130/80 mmHg. Many specialists prefer to start with a low dose of an ACE inhibitor or angiotensin receptor blocker; add a low dose of a thiazide; add a low dose of a calcium channel blocker; and finally, add a low dose of a cardiospecific beta blocker. If this regimen does not bring BP to the goal of therapy, doses of each agent are then raised in a stepwise fashion until goal of < 130/80 mmHg is reached.There are many variations on this scheme. Whatever approach is used, the evidence is strong that ACE inhibitor and/or ARB therapy must be used and that persistent adjustments are often necessary to achieve BP goals in type 1 diabetic patients with nephropathy and hypertension.*232\357\8*

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