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Resistant Hypertension in Adults With Type 1 or 2 Diabetes: A Structured Diagnostic Approach.
1Home Dialysis, Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.
Canadian Journal of Diabetes
|April 1, 2018
Summary
People with diabetes often struggle with resistant hypertension. A structured approach, focusing on adherence and medication review before rare secondary causes, helps achieve blood pressure targets.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Diabetes mellitus is frequently associated with hypertension, with many patients failing to reach target blood pressure levels.
- Resistant hypertension, defined as blood pressure remaining elevated despite optimal medication regimens, is common in diabetic individuals.
- Prompt screening for secondary causes of hypertension in this population is often performed, though these causes are rare.
Purpose of the Study:
- To outline a structured, systematic approach for managing resistant hypertension in patients with diabetes.
- To emphasize common, treatable causes of resistant hypertension over rare secondary etiologies.
- To guide clinicians in optimizing blood pressure control for diabetic patients.
Main Methods:
- Implementing out-of-office blood pressure monitoring (home or ambulatory) as a primary step.
- Assessing patient adherence to prescribed antihypertensive medications.
- Identifying potential interfering substances or drug interactions.
- Evaluating the synergy and optimal dosing of current antihypertensive regimens.
- Considering secondary causes of hypertension only after addressing common factors.
Main Results:
- A structured, stepwise evaluation can effectively identify reasons for uncontrolled blood pressure in diabetic patients.
- Focusing on adherence, medication review, and interfering substances often resolves apparent resistant hypertension.
- This systematic approach facilitates achievement of blood pressure targets in a challenging patient group.
Conclusions:
- Resistant hypertension in diabetes often stems from common, manageable factors rather than rare secondary causes.
- A structured diagnostic pathway is crucial for optimizing blood pressure control in patients with diabetes.
- Clinicians should prioritize adherence assessment and medication optimization before pursuing extensive secondary cause investigations.
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