Hosted by Ray Shields, MD

Cardiovascular disease (CVD) is the major cause for mortality and a significant cause of morbidity for individuals with diabetes.  Addressing dyslipidemia and hypertension is critical, given that lowering blood sugar alone is not adequate to address the CVD risk in diabetes.  Patients with type 2 diabetes have an increased prevalence of hypertension and lipid abnormalities including high triglyceride and low HDL levels that contribute to the higher rates of CVD.  Management of hypertension and lipids results in significant CVD risk reduction for people with diabetes. The following recommendations represent our best clinical understanding and approach at the present time; this will evolve as our understanding improves from further outcome studies.

Assessment and Management of Blood Pressure

Blood Pressure (BP) control reduces risk for diabetic microvascular and macrovascular complications and is a priority for America Indians and Alaska Natives with diabetes.

Accurate BP measurement in the office is essential for diagnosis and treatment of elevated BP. Ambulatory and home monitoring should be considered if the diagnosis or control of hypertension is in question by office readings.

Major lifestyle modifications have been shown to lower BP.  These include weight reduction in overweight or obese individuals and adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan. The DASH eating plan emphasizes consuming foods rich in potassium and calcium, reducing dietary sodium, increasing physical activity, and cutting down on alcohol consumption.

Treatment with 2 or more antihypertensive agents is frequently required to achieve BP targets. Antihypertensive agents are initiated in a step progression and selected based on the patient’s coexistent conditions and desired secondary benefits as outlined in JNC VII.  ACE Inhibitors or ARBs offer renal protection and improve insulin sensitivity.