Blood pressure reduction for patients with diabetes

Drug treatment to reduce blood pressure is important in prevention of both microvascular complications and cardiovascular disease in patients with diabetes. The benefits of blood pressure reduction in patients with diabetes have been observed regardless of initial blood pressure.

See Management of diabetic kidney disease for information about use of blood pressure–lowering drugs to slow progression of diabetic kidney disease.

To reduce blood pressure in patients with diabetes, use an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) as first-line drug treatment. See Blood pressure reduction for advice about using ACEIs or ARBs to reduce blood pressure, including cautions, dosage and monitoring required. When increasing up to the highest tolerated ACEI or ARB dose, dose escalation may be limited by the patient’s ability to tolerate the reduction in blood pressure and adverse effects of the drug. If a patient cannot tolerate one class of drug (eg ACEI), a drug from a different class (eg ARB) should be substituted.

Most patients with diabetes and elevated blood pressure require more than one drug to reduce their blood pressure. Consider adding a long-acting calcium channel blocker or a low-dose thiazide or thiazide-like diuretic to treatment with an ACEI or an ARB. See Approach to drug therapy for blood pressure reduction for advice on using drug combinations to reduce blood pressure.