Both hypertension and diabetes are highly prevalent chronic diseases among people today, and it is not uncommon to find both chronic diseases in a single person at the same time. Hypertension can raise the cardiovascular risk of diabetics nearly twofold, and diabetes can also raise the cardiovascular risk of hypertensive people twofold, and the net effect of cardiovascular harm of the two coexisting is 4-8 times greater than that of the general population, with a 7.2-fold increase in the rate of death from their diseases.

Target blood pressure in diabetics should be flexible!

Previous guidelines recommended a target blood pressure of <130/80 mmHg in patients with diabetes, but the purpose of the blood pressure trial in the ACCORD study (Controlling Cardiovascular Risk in Patients with Diabetes Trial), published in 2010, was to compare in patients with type 2 diabetes whether an intensive approach to blood pressure lowering (systolic blood pressure <120 mmHg) was more effective than the standard blood pressure lowering regimen (systolic blood pressure <140 mmHg) in reducing the cardiovascular event rates. The results showed that intensive blood pressure lowering failed to significantly reduce the risk of all-cause mortality and cardiovascular death, but the risk of stroke was significantly reduced: at the same time, intensive blood pressure lowering could lead to an increased risk of serious adverse events. Regarding the effect of systolic blood pressure <130 mm Hg on the risk of endpoint events, post hoc analyses need to be conducted to evaluate this.

The ONTARGET study (Timosartan and Ramipril Cardioprotection Trial) is a large-scale clinical study of cardiovascular protection. Its post hoc analysis showed that in patients at high cardiovascular risk, the cardiovascular benefit of a systolic blood pressure <130 mmHg was mainly due to a reduction in strokes, with no significant change in the risk of myocardial infarction and no significant change or increase in cardiovascular mortality.

Based on the above evidence-based medicine, the 2009 ESH/ESC Guidelines for Hypertension make the following recommendations for evaluating antihypertensive goals for patients with diabetes and those at high cardiovascular risk:A blood pressure of <140 mmHg is an acceptable target level for patients with diabetes. In patients with newly diagnosed type 2 diabetes mellitus, strict control of risk factors should be emphasized; however, target blood pressure levels should be flexible in older patients with a long history of diabetes mellitus and in patients with numerous comorbidities.

Antihypertensive therapy in patients with diabetes mellitus combined with hypertension!

For such patients, lowering blood pressure is the first goal, and some studies have shown that for every 10 mmHg drop in systolic blood pressure, any diabetes-related complications, death, myocardial infarction, and microvascular complications can be reduced by more than 10%.

Diabetic patients with systolic blood pressure at 130-139 mmHg or diastolic blood pressure at 80-89 mmHg may be treated with non-pharmacological therapy (healthy diet, reduction of body weight, reduction of sodium intake, and moderate daily exercise) for a period of not more than 3 months, and if the blood pressure doesn't improve, then pharmacological therapy must be taken.

Patients with blood pressure ≥140/90 mmHg or microalbuminuria should be treated with both nonpharmacologic and pharmacologic therapy.

Since patients suffer from both diabetes and hypertension, then cardiovascular and renal target organ damage needs to be minimized during the antihypertensive process, and a large amount of clinical data suggests that RAS inhibitors such asACEI (captopril, enalapril, benazepril, perindopril, etc.) or ARB (chlosartan, irbesartan, valsartan, timosartan, etc.) are the drugs that can significantly reduce the risk of new-onset diabetes mellitus among all antihypertensive medications, and can significantly improve insulin resistance, comprehensively act on all aspects of the metabolic syndrome, and are also the best among all antihypertensive medications in reducing microproteinuria, so the two are the The first-line drugs in the treatment of hypertension combined with diabetes mellitus are preferred when a single drug is effective, and one of them should be used as the basis when a combination is needed, but regular checks of potassium and renal function are needed when applying the two.

ACEIs and ARBs are uniquely protective of the kidneys and have metabolic benefits, and both are applied as soon as microalbuminuria occurs. In type 1 diabetes, ACEIs have been shown to delay the progression of renal complications, and both ARBs and ACEIs delay the development of massive albuminuria in type 2 diabetes. In patients with type 2 diabetes combined with massive albuminuria or renal insufficiency, ARBs are recommended as the drug of choice for lowering blood pressure。

And diuretics and beta-blockers can delay the progression of nephropathy in patients with type 1 diabetes mellitus, so they can also be used as therapeutic drugs for such patients, but they are generally not preferred as monotherapy, and they are mostly used as secondary drugs or in combination; diuretics and beta-blockers should be used in small doses, for example, the daily dosage of hydrochlorothiazide is no more than 12.5-25mg, in order to avoid the adverse effects on blood lipids and glucose; diuretics should be used cautiously in patients with combined Diuretics should be used with caution in patients with combined hyperuricemia or gout; β-blockers should be used with caution in patients with type 1 diabetes with recurrent hypoglycemic episodes so that they do not mask hypoglycemic symptoms.

Hypertension combined with diabetes mellitus patients with blood pressure to reach the standard, can be under close observation and patient tolerance on the basis of as much as possible to continue to stabilize the lowering of blood pressure, the vast majority of patients should be used in the combination of antihypertensive, as mentioned above, which should include an ACEI or ARB, the lowering of blood pressure in elderly patients should be gradual and step-by-step to reach the standard, the standard of blood pressure can be appropriately relaxed, such as 140/90 mm Hg as a therapeutic target, to avoid blood pressure sudden drop causes insufficient blood supply to the organs.

In fact, when we were in college, including graduate school, we were required to focus on some important and common diseases, such as tumors, such as hypertension, such as diabetes. It is possible that we have studied the pathology of such diseases in pathology, and when we come to internal medicine or other courses, we may repeat the study many times again, and then we may add some new things, such as diagnosis, such as treatment, and so on. Therefore, for some common and frequent diseases, all medical students and doctors, should focus on mastering them to better serve their patients.Today, Dr. Zhang will talk to you about how we should reasonably lower our blood pressure when hypertension meets diabetes. First of all, Dr. Zhang once emphasized that hypertension and diabetes are common chronic diseases, and the possibility of the two together is still relatively high. Here we look at a set of data: according to statistics found that the prevalence of diabetes in patients with hypertension is about 18%. And diabetic patients if at the same time combined with hypertension, the likelihood of cardiovascular and cerebrovascular events will be significantly increased (at least twice as much as simple hypertension or simple diabetes), and its risk of death will increase 7.2 times. In patients with hypertension combined with diabetes, for every 10 mm Hg drop in systolic blood pressure, the risk of any complication related to diabetes decreases by 12% and the risk of death by 15%. Therefore, when both diseases are present, we should control our blood sugar and blood pressure wisely.

So how do you deal with lowering blood pressure and sugar?

After many discussions and studies by our hypertension experts and studying the relevant guidelines and literature, it is now believed that the goal of blood pressure lowering for general diabetic patients is <130/80mm Hg; the goal of blood pressure lowering for elderly or diabetic patients with severe coronary artery disease is <140/80mm Hg. With the above goal of lowering the blood pressure, you can choose the appropriate antihypertensive program according to your situation. For example, for patients with both hypertension and diabetes mellitus, if there is no contraindication, we will give priority to sartan-type antihypertensive drugs, prilosec antihypertensive drugs and diphenhydramine antihypertensive drugs.

For these patients, the guidelines recommend that the blood glucose control target: glycated hemoglobin <7%, fasting blood glucose between 4.4-7.0mmol/l, 2 hours after meal blood glucose <10.0mmol/l. For the elderly who are prone to hypoglycemia, and patients with a lot of comorbidities, blood glucose target can be appropriately relaxed. Drug selection, in recent years, the new hypoglycemic drugs SGLT-2 class of drugs (dagliflozin, engeleukin, cagliflozin), because of its hypoglycemic effect is good, and at the same time both antihypertensive effect, cardiac and renal protection effect is obvious, and has attracted much attention.

In addition to this, Dr. Zhang would like to remind everyone that while medication is being administered, lifestyle intervention must not be neglected, and both hands must be grasped, and both hands must be hardened.

Hypertension and diabetes are both common chronic diseases, both can damage the heart, blood vessels, kidneys and other vital organs and tissues, if both exist at the same time, the damage to the target organs is much higher than the harm caused by a single disease. If both hypertension and diabetes mellitus exist at the same time, how to control the blood pressure is more reasonable? Next, Medical Senlution will analyze for you.

About a quarter of hypertensive patients have diabetes mellitus, which significantly increases the risk of cardiovascular and cerebrovascular events and mortality; on the contrary, if blood pressure is actively controlled, the cardiovascular and cerebrovascular risk and mortality rate can be reduced. Therefore, in the formulation of antihypertensive goals, ordinary hypertensive patients can be controlled below 140/90mmHg, but hypertensive patients with diabetes mellitus should control their blood pressure in a lower range. According to statistics, when hypertension is combined with diabetes mellitus, for every 10mmHg reduction in systolic blood pressure, the complications of diabetes mellitus will be reduced by about 12%, and the risk of death will be reduced by about 15%, therefore, it is more reasonable to control the blood pressure of patients with hypertension combined with diabetes mellitus at below 130/80mmHg.

In the formulation of antihypertensive program, the ideal blood pressure is 120/80mmHg or less, when the blood pressure is more than 120/80mmHg but less than 130/80mmHg, attention should be paid to lifestyle changes, i.e., non-pharmacological treatment, including low-salt, low-sugar, low-fat, low cholesterol, high-potassium diets, appropriate exercise, smoking cessation and limitation of alcohol, and weight reduction, etc.; when the blood pressure is higher than 130/80mmHg, but lower than 140/90mmHg, it is recommended to adhere to non-pharmacological treatment for three months, if the blood pressure can be controlled below 130/80mmHg, then non-pharmacological treatment can be continued, if the standard has not been reached, then medication should be initiated immediately to lower blood pressure; when the blood pressure reaches 140/90mmHg, medication should be initiated immediately to lower blood pressure.

在药物的选择上，高血压合并糖尿病降压药优选ACEI（普利类降压药）或ARB（沙坦类降压药），二者不仅降压疗效优越，而且可改善胰岛素抵抗，可减轻高血压与糖尿病对肾脏的损害，减轻蛋白尿，降压效果欠佳时，可联用小剂量利尿剂或CCB（地平类降压药），他们与ACEI或 When the antihypertensive effect is unsatisfactory, small-dose diuretics or CCBs (diphenhydramine antihypertensive drugs) can be used in combination with ACEIs or ARBs, and they are the preferred combined antihypertensive regimen; however, β-blockers should be used with caution because they can mask hypoglycemic symptoms, unless combined with angina pectoris or myocardial infarction.

In summary, hypertension combined with diabetes mellitus, blood pressure should be controlled below 130/80mmHg; when blood pressure is lower than 130/80mmHg, the treatment is to change lifestyle; when blood pressure is higher than 130/80mmHg but lower than 140/90mmHg, non-pharmacological treatment should be given for three months first, and medication should be initiated to lower blood pressure if the blood pressure does not reach the standard after treatment; when blood pressure reaches 140/ 90mmHg, drug lowering of blood pressure should be initiated immediately; antihypertensive drugs are preferred to ACEI or ARB, and combined drugs are used if necessary.

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Whether you have high blood pressure first and then have diabetes with elevated blood sugar, or you have diabetes first and then find that your blood pressure is gradually increasing, hypertension combined with diabetes is a problem that deserves our attention. Hypertension affects kidney health and increases the risk of kidney damage caused by diabetes, while diabetes jeopardizes cardiovascular health and increases the risk of cardiovascular and cerebrovascular diseases in hypertensive patients. Therefore, for patients with hypertension combined with diabetes, it is important to pay attention to both the control of blood pressure and the assurance of a good level of glucose, in order to better minimize the health hazards that hypertension and diabetes may bring to the heart, brain, and kidneys.

Today do not talk about the control of diabetes, alone to talk about high blood pressure to lower the problem, before talking about how to lower the pressure, we first talk about hypertension combined with diabetes friends of the lowering of the target for hypertension combined with diabetes friends, if the age of 65 years old or older, recommended to control the blood pressure to high pressure to 130 or less, low pressure control in 80 or less, this 130/80 level of compliance, not casually said! years of clinical research data show that blood pressure control to 130/80 below, than control to 140/90 below, although the risk of cardiovascular disease to reduce the effect is not obvious, but for the incidence of stroke to reduce the chances of more significant effect, and diabetes combined with high blood pressure patients, is an infarction stroke and hemorrhagic stroke of the high-risk group, so, control blood pressure to 130/80 Therefore, it is more reasonable to control blood pressure below 130/80. For elderly people over 65 years old, the standard can be relaxed according to their own physical tolerance.

Hypertension combined with diabetes mellitus patients, how to lower blood pressure? We then talk about the choice of drugs before, or to nag a few words, for high blood pressure combined with diabetic problems of friends, pay more attention to life on the conditioning, if both high blood pressure and diabetes, in terms of life conditioning, if you can adhere to a good and healthy habits, not only for blood pressure control has a very good auxiliary effect, at the same time for the lowering of blood glucose, to improve insulin resistance, protection of cardio-cerebral and cerebral vascular health, etc., the healthy habits are the basis for controlling the disease, but also to reduce blood pressure. Healthy living habits are the foundation of disease control. Specifically what should be done, we talk a lot, not to say more, to give you four words.Low-salt and low-sugar reasonable diet, adhere to exercise to control body weight, calm mind and good sleep, quit smoking and limit alcohol to live a healthy life.。

Then come to the issue of medication for patients with hypertension combined with diabetes mellitus, usually we say that the first level of hypertension patients with blood pressure does not exceed 160/100, you can consider not to use medication first to reduce and control blood pressure by way of life regulation, but if you have diabetes mellitus, in the life of the same time, it should be earlier application of antihypertensive drugs to control blood pressure, the reason why diabetes mellitus high blood pressure should be used as early as possible, the main reason is to The main reason why diabetic hypertension should be medicated as early as possible is to consider controlling blood pressure as early as possible, to improve the rate of blood pressure control, and to reduce the risk of health damage caused by the combination of the two diseases as early as possible.

Patients with diabetes mellitus combined with hypertension are preferred in the selection of antihypertensive drugsSartans or PrilosecAntihypertensive drugs, these drugs in the effective reduction of blood pressure under the premise, but also able to improve renal artery blood flow, with the role of protecting the kidneys, for diabetes caused by mild proteinuria problem, but also has a certain improvement and control effect, is diabetes combined with hypertension friends choose antihypertensive drugs of choice, if there is high blood pressure also have diabetes problems, mild hypertension problems, choose Prilosec or sartan drugs, single drugs Taking is generally able to put the blood pressure under effective control. If you need a combination of drugs, you can considerCombination of diphenhydramine antihypertensive drugs with sartan or prilosec drugsThe drug has no adverse effect on blood glucose metabolism, and has some cardiovascular protection, and is also an option for patients with hypertension combined with diabetes mellitus.

Usually for diuretics and beta-blocker analogs, there may be adverse effects on blood glucose metabolism, and is not the preferred antihypertensive medication in non-essential cases, while if it is really necessary to use, it is recommended to choose low-dose diuretics for short-term application or highly selective beta-blocker analogs, which can reduce the effect of such antihypertensive medications on blood glucose.

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In recent years, the incidence of hypertension and hyperglycemia in China has been increasing year by year, but because of the low rate of awareness and compliance, it has caused different degrees of damage to the heart, brain, kidney and other related target organs. So next, we focus on this situation, focusing on the rational choice of antihypertensive drugs as well as blood pressure management in diabetic patients!

Characteristics of hypertension in patients with diabetes mellitus

(1) Most often manifests as a marked increase in systolic (high) blood pressure;

(2) Prone to postural hypotension, i.e., a sudden change in position (when changing from sitting to standing) with a sudden drop in blood pressure;

(3) Tend to have an increased heart rate;

(4) Both diabetes and hypertension can cause kidney damage, and when the two diseases are superimposed, both are more likely to cause kidney damage.

How to choose antihypertensive drugs for diabetics

(1) ACEIs (Prilosec) and ARBs (Sartans): The effect is to lower blood pressure by reducing the amount of angiotensin synthesis; it can also reduce the level of proteinuria and improve renal function; and it has a small effect on blood glucose, so diabetic patients can choose to use it under the guidance of their doctors.

(2) Calcium antagonists (diphenhydramine): by preventing calcium ions from entering the heart muscle and smooth muscle cells, thus lowering blood pressure; it does not affect lipid, glucose and electrolyte metabolism, but reduces proteinuria and improves renal function. Therefore, diabetic patients with high blood pressure under the guidance of a doctor to choose to use.

(3) Diuretics: By reducing blood volume to lower blood pressure treatment, in common parlance, is "open the floodgates", so with the reduction of blood volume, blood glucose will fluctuate and rise; in addition, some diuretics (e.g., thiazides) will lead to hypokalemia, reduce insulin sensitivity, and elevate blood glucose. Therefore, diabetic patients with high blood pressure, is not recommended for routine application, if necessary, it is recommended to use in small doses under the guidance of a doctor.

(4) Beta-blockers (Lorazepam): affect the sympathetic innervation of the heart muscle by blocking beta receptors, thus lowering the heart rate and blood pressure; at the same time, they affect the pancreas's secretion of insulin, leading to fluctuations in blood glucose. Therefore, for diabetic patients with high blood pressure, routine use is also not recommended, and blood glucose changes must be monitored in a timely manner if needed.

What else is involved in managing blood pressure in diabetes?

(1) Most diabetic patients strive to lower their blood pressure to less than 130/80 mmHg, and try to control it to less than 140/90 mmHg for patients of advanced age with poor blood pressure control;

(2) Lifestyle management must be adhered to from the beginning to the end: it includes comprehensive treatment such as reasonable and healthy diet, moderate and regular exercise, strict weight control, and precise cessation of smoking and alcohol restriction.

Dr. Duan specifically warned:

(1) Diabetes mellitus combined with hypertension is a high-risk factor for cardiovascular and cerebrovascular events, and it is important to aim for a blood pressure below 130/80 mmHg;

(2) Choosing the right medication is the only way to get twice the result with half the effort. Therefore, it is necessary to make a comprehensive assessment and choose the appropriate antihypertensive medication;

(3) Emphasize comprehensive treatment and strengthen lifestyle interventions and follow through with them

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Hypertension combined with diabetes mellitus will greatly increase cardiovascular and cerebrovascular damage, accelerate the occurrence of retinopathy and nephropathy, so reasonable antihypertensive can reduce the occurrence of cardiovascular and cerebrovascular accidents, mitigate the damage to the target organs, reduce the lethality and improve the quality of life.

Rational blood pressure lowering is mainly a rational choice of antihypertensive drugs

The general principle of antihypertensive drug selection is long-lasting and smooth blood pressure lowering with a protective effect on target organs.

1. The choice of drugs preferred ACEI class (such as captopril, enalapril, etc.) and ARB class (such as chlosartan, valsartan, etc.), if the use of a drug can not control the symptoms, it is necessary to use a combination of drugs to ACEI class or ARB class based on the combination of (ACEI class and ARB class do not combine).

Prilosec and sartan antihypertensive drugs essentially have the same mechanism of action, preventing proteinuria in diabetic patients, reducing proteinuria excretion, delaying the development of renal disease, improving glucose metabolism, and having a protective effect on target organs;

2. CCB class (e.g. nifedipine, amlodipine) can be chosen. Dipyridamole acts on vascular smooth muscle to block the inward flow of cellular calcium ions, thus reducing peripheral vascular resistance and lowering blood pressure. It has no effect on glucolipid metabolism. Dipyridamole can be combined with ACEI or ARB drugs for a synergistic effect;

3. Selective β-blockers (e.g. metoprolol) can be chosen because they have little effect on blood glucose and blood lipids. Non-selective β-blockers (e.g. propranolol) should not be chosen because they have adverse effects on glucose and lipid metabolism and may aggravate diabetic peripheral vasculopathy.

4. Small doses of thiazide diuretics are also available, such as hydrochlorothiazide, usually in combination with ACEIs or ARBs, which can have a synergistic effect.

5 If ACEIs or ARBs are chosen, serum creatinine and blood uric acid levels should be monitored, and if the blood creatinine is >265 mmol/L, or the eGFR is less than 30 ml, a diphenhydramine antihypertensive agent should be chosen.

6. Diuretics are not recommended if you have hyperuricemia or gout.

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"Three high" this word we may be very familiar with, but specifically talking about which "three high", many people are not too clear, in fact, "three high" refers to high blood pressure, high blood sugar, High blood pressure, high blood sugar, high blood fat, why always mention the "three high" it, because this "three high" is closely linked, China's outpatient hypertension patients 24.3% combined with diabetes mellitus, hypertension is often combined with abnormal glucose metabolism,. Hypertension can make the cardiovascular risk of diabetic patients increased nearly two times, diabetes can also make the cardiovascular risk of hypertensive patients increased two times, the two coexist cardiovascular hazards of the net effect of the general population is 4 to 8 times, in short, hypertension combined with diabetes patients occur heart attack, cerebral infarction, heart failure, peripheral vascular disease and chronic kidney disease and other diseases of the risk of larger. It has been shown that for every 10 mmHg drop in systolic blood pressure in patients with diabetes combined with hypertension, the risk of diabetes-related complications can be reduced by 12% and the risk of death by 15%.

It can be seen that patients with hypertension and diabetes at the same time, blood pressure control is very important, the "2018 China Hypertension Guidelines" pointed out that hypertension combined with diabetes in patients with blood pressure control standards is 130/80 mmHg, which, the elderly or with serious coronary artery disease patients, can be relaxed to lower the target value of 140/90 mmHg, to avoid the occurrence of cardiovascular accidents.

For patients with hypertension combined with diabetes mellitus, the choice of antihypertensive drugs should not only take into account the effect of controlling blood pressure, but also, more importantly, be able to take into account the protection of vital organs or delay the occurrence and development of diabetic complications.

Choice of antihypertensive drugs: ACEI (captopril, benazepril, enalapril, etc.)/ARB (valsartan, chlorosartan, irbesartan, candesartan, etc.) is preferred, and ARBs can be prioritized in view of their better safety and adherence in China. When it is necessary to combine with other classes of antihypertensive drugs, it can also be prioritized to be combined with one of them.

For patients with micro-proteinuria, the combination of ACEI/ARB should be chosen, as both drugs can reduce urinary protein and play a renoprotective role.

If BP is still poorly controlled, diuretics (hydrochlorothiazide, etc.) or CCBs (nifedipine, amlodipine, verapamil, diltiazem, etc.) may be added, and beta-blockers (metoprolol succinate, etc.) may be added for angina.

Currently on the market more types of hypertension drugs, history is also longer, related to the safety and effectiveness of medication research is also more, patients and friends can not be too worried about the side effects of multi-drug combination, and self-adjustment of antihypertensive drugs, only good blood pressure control, in order to better protect the cardiovascular and cerebral vascular, reduce the incidence of complications.

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How to choose antihypertensive drugs for patients with diabetes mellitus combined with hypertension

Li Qing, Tianjin TEDA Hospital

Hypertension and diabetes mellitus are two of the most common chronic diseases, and they are like a pair of bad brothers, with similar pathogenic factors, often co-existing and affecting each other. Studies have shown that 55.9% of the hypertensive population has abnormal glucose metabolism, while 58% of the diabetic population has hypertension.

Diabetes mellitus and hypertension are both important "drivers" of cardiovascular disease and death, and the risk of atherosclerotic cardiovascular disease is further increased when the two coexist, with the risk being 1+1＞2. On the one hand, it is more difficult to regulate blood glucose, and on the other hand, the risk of macrovascular and microvascular lesions is higher.

I. Antihypertensive treatment of diabetes mellitus combined with hypertension

Studies have found that 35%-75% of diabetes complications are associated with high blood pressure. A well-known international study showed that intensive blood pressure lowering is more beneficial than intensive glucose lowering in diabetic patients, and that lowering blood pressure is at least as important as lowering glucose, if not more so.

The 2010 edition of the Chinese guidelines for the prevention and treatment of type 2 diabetes mellitus suggests that the aim of strict blood pressure control in patients with diabetes mellitus combined with hypertension is to minimize target organ damage and reduce the risk of cardiovascular disease and death.

1. Goals of blood pressure control

Earlier guidelines recommended that the goal of blood pressure control in patients with diabetes mellitus combined with hypertension should be <130/80 mmHg. However, since then, between 2009-2014, some scholars in Europe and the United States have concluded that diabetic patients do not benefit more from strict blood pressure control, and therefore recommended that the goal of their blood pressure control should be relaxed to <140/90 mmHg.

It has since been argued that while there is insufficient evidence for a <130/80 mmHg goal, there is also no evidence that this goal adversely affects patients. In contrast, blood pressure control in diabetic patients is generally inadequate, so several recently updated guidelines have again tended to be more stringent in their blood pressure control strategies. For example, the 2014 Japanese Hypertension Guidelines, the 2015 Taiwan Hypertension Guidelines and Canadian Hypertension Guidelines, and the recently updated consensus of the American Association of Endocrinologists (AACE) and the American College of Endocrinology (ACE) all recommend a target blood pressure of <130/80 mmHg in patients with diabetes mellitus combined with hypertension.

Our guidelines recommend a blood pressure lowering goal of <140/90 mmHg, with a goal of <130/80 mmHg for younger patients or those with combined renal disease.China is a stroke-prone region, and strict control of blood pressure is important for reducing the risk of stroke, so diabetic patients with good tolerance should have their blood pressure controlled to less than 130/80 mmHg.

In conclusion, the recommendations of the relevant domestic and international guidelines on the target value of blood pressure control for patients with diabetes mellitus combined with hypertension is <130/80 mmHg, which is basically the same.

2. Selection of antihypertensive drugs

Blood pressure control in patients with diabetes mellitus combined with hypertension is firstly carried out by lifestyle intervention, and the intervention measures are mainly health education, rational diet, regular exercise, smoking cessation and salt limitation, weight control, psychological balance, and so on. If the blood pressure cannot reach the standard after 3 months of lifestyle intervention, or if the blood pressure is ≥140/90mmHg at the initial diagnosis, drug treatment should be started.

There are six main categories of antihypertensive drugs currently in clinical use:

1. ACEI (Priligy): including Benadryl, Ramipril, Fosinopril, Captopril, and so on;

2, ARB (sartans): including valsartan, cloxartan, irbesartan, timosartan, candesartan and so on;

3. CCB (diphenhydramine): including amlodipine, felodipine, nifedipine, and so on;

4、Beta-blockers: including Betalucil, Almar, etc.;

5, diuretics: including thiazide diuretics hydrochlorothiazide and thiazide-like diuretics indapamide, etc.; 6, alpha-blockers: terazosin and so on.

The first five of these categories can all be preferred as first-line antihypertensive drugs for diabetic patients.

In the choice of drugs, in addition to considering the efficacy of antihypertensive, should also consider the choice of antihypertensive drugs have no cardiovascular, cerebral, renal and other organs of the protective effect, whether to reduce the large blood vessels and microvascular complications, the drug has no effect on blood glucose and so on.

I. Preferred Drugs:

It is generally believed that prilosec and sartans antihypertensive drugs can delay the progression of diabetic nephropathy and retinopathy, so they should be chosen first.

The American Society of Hypertension recommendations for the treatment of diabetes mellitus with hypertension are that all patients with diabetes mellitus with hypertension should be started on antihypertensive therapy with either a prilosec or a sartan antihypertensive agent in order to minimize cardio-renal complications, and that both should be increased to the maximum dose required to achieve compliance within one month of the start of therapy. And the American Diabetes Association recommendations for the treatment of diabetes mellitus with hypertension are that the treatment regimen for hypertension must include either a prilosec or a sartan.

Combined use of Prilosec and sartans, the antihypertensive efficacy increase is not obvious, but lead to high blood potassium and blood creatinine elevation of the side effects are significantly increased, so the two are not currently recommended for use in combination. Pulisodic drugs have dry cough and other side effects, the incidence of high blood potassium and blood creatinine elevation is also significantly higher than that of sartans, so the current diabetes mellitus combined with hypertension antihypertensive more preferred sartans antihypertensive drugs.

II. Combined drugs

The treatment of diabetes mellitus combined with hypertension is difficult to achieve with a single drug and often requires a combination of drugs. It is generally recognized that if the blood pressure is >150/100mmHg it should be treated directly with a combination of two or more drugs.

Among the combination drugs, it is recommended to prefer long-acting depressants such as amlodipine benzenesulfonate (represented by Lovenox), nifedipine controlled-release tablets (represented by Bactrim), and felodipine sustained-release tablets (represented by Boydine). Short-acting depressants such as nifedipine tablets are prohibited.

Recommended Programs:

Sartans are preferred, one tablet taken orally once daily;

If blood pressure is not up to standard, or if you start with a blood pressure >150/100 mmHg, change to sartans + long-acting diphenhydramine, one tablet of each, taken orally once a day;

If your blood pressure is still not up to par, add another hydrochlorothiazide tablet, also taken orally once a day;

If your blood pressure is still not up to par, add a beta-blocker, one tablet at a time, to be taken orally twice a day.

Hypertension, diabetes mellitus and hyperlipidemia are known as the "three highs" of "diseases of wealth" and "diseases of civilization".Three highs = high prevalence + high medical costs + high riskThe three highs are the cause and effect of each other. The three highs are the cause and effect of each other, and the harmful effects are superimposed, so that the risk of cardiovascular and cerebrovascular diseases is greatly increased, which seriously affects the quality of life and life expectancy of the patients.

Diabetes mellitus and hypertension may have common genes, and high blood glucose is also prone to cause hypertension, so the two are regarded as homologous diseases in medicine. Epidemiologic data show that 40% to 45% of people over the age of 60 who suffer from hypertension also suffer from diabetes, and about 50% of diabetic patients have hypertension as a complication. It is not surprising that two diseases in one patient can be very dangerous to health! Therefore, the assessment of the condition of patients with hypertension combined with diabetes mellitus is very high-risk, as shown in the figure

Treatment once hypertension is diagnosed with diabetes, regardless of how many levels of hypertension, should immediately start antihypertensive drug treatment, do not simply lifestyle intervention treatment. That is, medication plus lifestyle intervention in two aspects are to be, two are indispensable.

1, the first choice of antihypertensive drugs for "Prilosec" (angiotensin-converting enzyme inhibitors, ACEI) or "sartans" (angiotensin receptor antagonists, ARB). Such as commonly used enalapril, irbesartan and so on.

Because the condition is very high risk, blood pressure is usually controlled by a combination of 2 classes of antihypertensive drugs with different principles of action (in rare cases, one of the two classes is preferred for good control). These two classes are either one or the other (e.g., "diphenhydramine").

A large number of evidence-based medicine has proved that this type of antihypertensive drugs not only control blood pressure, but also protect hypertension and diabetic target is also very good. Such as preventing or reversing left ventricular hypertrophy, adjusting metabolism, protecting the kidneys, reducing the excretion of proteinuria caused by renal damage, and improving vascular atherosclerosis and other effects.

Such as high-dose diuretics, or non-selective beta-blocker drugs, can cause blood chaff, elevated blood lipids, etc., try not to use.

Drug action is complex, and different individual patients have different effects and side effects. If you want to use the medication safely and effectively for a long period of time and control your blood sugar and blood pressure, it is recommended that you must follow up the treatment and observe it for a long period of time under the guidance of a professional doctor, have regular medical checkups, and adjust the medication if necessary.

This is a variety of chronic diseases accumulated in one lifestyle improvement methods, coupled with a low-fat diet, obese or overweight people also have to reduce weight,! Lifestyle intervention treatment, not only can reduce blood pressure, but also reduce blood glucose, blood lipids, prevention and treatment of cardiovascular disease and its complications, enhance the effect of drugs, reduce the drug thing role.

Key Note: Eat smaller meals and consume more dietary fiber. Green leafy vegetables with high dietary fiber content, such as Chrysanthemum coronarium, are the first choice of diet for patients with hypertension complicated by diabetes. Drink foods rich in calcium, potassium, vitamin C and alpha-linolenic acid.

Diabetes mellitus combined with hypertension, which is not uncommon, for such patients should pay more attention to the control of blood pressure, because their blood vessels to withstand high blood glucose, high blood pressure double damage, more prone to diabetic complications, such as cardiovascular and cerebrovascular disease, diabetic nephropathy, diabetic fundus lesions. In terms of medication, it is never as simple as "diabetes medicine + hypertension medicine"!

How do I control my blood pressure with medication?

When choosing antihypertensive drugs for diabetic patients, comprehensive consideration should be given to factors such as efficacy, cardio-protective and renal protective effects, safety and compliance as well as the effect on metabolism. Specific medications need to be prescribed by an endocrinologist, and patients should not discontinue or change medications at will. Pharmacists in social pharmacies must also pay attention to the above principles when providing guidance to such patients.

Drugs should start with a small dose, unsatisfactory results can increase the dose or with other drugs, generally 2 ~ 3 antihypertensive drugs can be used in combination, which can enhance the antihypertensive effect, but also can reduce adverse effects.

Blood pressure control requires 24-hour stabilization. Whenever possible, use a long-acting antihypertensive medication that can be taken 1 tablet daily to minimize fluctuations in blood pressure and to facilitate long-term adherence to treatment.

Some medications, such as the diuretic hydrochlorothiazide, can raise blood glucose, and beta-blockers can mask the early symptoms of hypoglycemia and should be used with caution under medical supervision.

Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are now recognized as the drugs of choice for patients with diabetes mellitus combined with hypertension, reducing urinary microalbumin, delaying the onset and progression of diabetic nephropathy, and decreasing the incidence of heart failure and myocardial infarction.

Life diet, you can reduce salt intake to assist in lowering blood pressure, the study pointed out that sodium intake by 6g / d, hypertensive people's blood pressure can be reduced by 7/4mmHg, normal people's blood pressure can be reduced by 4/2mmHg.