Hypertension management in T1D: expert opinion

  • Katsimardou A & al.
  • Expert Opin Pharmacother
  • 17.02.2020

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Hypertension is common in individuals with type 1 diabetes (T1D) and correlates with microvascular and macrovascular complications.
  • Because few data are available in that population to guide management, most recommendations rely on data from trials in type 2 diabetes (T2D).
  • There are differences in pathophysiologic mechanisms and cardiovascular burden between T1D and T2D, raising questions about the value of these recommendations in T1D.
  • T1D prevalence is rising.

Key recommendations

  • Antihypertensive treatment should be initiated promptly in grade 1 hypertension.
  • Patients with established cardiovascular disease should be treated when BP is within high-normal range.
  • BP should be lowered toward 130/80 mmHg and lower, if well tolerated, and targeted below 130/80 mmHg in high-risk individuals.
  • Lifestyle measures should always be implemented, even in individuals with high-normal BP.
  • 2-drug combination of a renin-angiotensin system inhibitor plus calcium channel blocker or thiazide/thiazide-like diuretic is recommended as initial pharmacotherapy.

Limitations

  • Lack of data in T1D leaves many unanswered questions, including:
    • Appropriate BP thresholds for treatment initiation and therapeutic goals.
    • Whether patients with T1D and albuminuria would benefit from antihypertensive treatment if their BP is high-normal.
    • Whether BP treatment initiation thresholds should differ in patients with vs without albuminuria.