Diabetes Type 2 - Anti-hypertensive Treatment Guidance

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • For adults with Type 2 Diabetes

Step One

  • Provide advice on lifestyle measures
  • First-line anti-hypertensive drug treatment should be a once daily, generic angiotensin-converting enzyme (ACE) inhibitor. Exceptions to this are people of African or Caribbean family origin, or women for whom there is a possibility of becoming pregnant (2009)
  • First line for a person of African or Caribbean family origin should be an ACE inhibitor plus either a diuretic or a generic calcium-channel blocker (CCB) (2009)
  • A CCB should be the first line treatment for a women for whom, after an informed
  • discussion, it is agreed there is a possibility of her becoming pregnant
  • If continuing intolerance to ACE inhibitor other than renal deterioration or hyperkalaemia substitute an angiotensin II –receptor antagonist (ARB) for the ACE inhibitor (2009)

Do not combine an ACE inhibitor with angiotensin II-receptor antagonist to treat hypertension (new 2015)

Step Two

  • If the person's blood pressure is not reduced to the individually agreed target with first line therapy review medication to ensure treatment is at optimal or best tolerated doses
  • Add a CCB or a diuretic(usually a thiazide or a thiazide related diuretic)
  • Add the other drug (that is, the CCB or diuretic) if the target is not reached with dual therapy (2009 amended 2015)

Repeat Blood Pressure measurements within:

  • 1 month if BP is higher than 150/90 mmHg
  • 2 months if BP is higher than 140/80 mmHg
  • 2 months if BP is higher than 130/80 mmHg and there is eye, kidney or cerebrovascular disease

Step Three - Resistant Hypertension

  • If the person's blood pressure is not reduced to the individually agreed target with triple therapy, add an alpha blocker,a beta blocker or a potassium sparing diuretic(the last with caution if the person is already taking an ACE inhibitor or an angiotensin II-receptor antagonist). [2009] Consider seeking specialist advice

Repeat Blood Pressure measurements within:

  • 1 month if BP is higher than 150/90 mmHg
  • 2 months if BP is higher than 140/80 mmHg
  • 2 months if BP is higher than 130/80 mmHg and there is eye, kidney or cerebrovascular disease

Targets for Blood Pressure Management

  • No end organ damage aim for <140/80 mm of Hg
  • End organ damage aim for <130/80 mm of Hg

Supporting information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Evidence/ Additional Information

Assurance & Governance

  • This guidance was developed on: 02.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 03.2017
  • Publication Date: 05.2017
  • Review Date: 02.2019
  • Ref No: END2 - 2.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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