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Treatment strategies for hypertension in patients with type 1 diabetes

Alexandra Katsimardou1, Konstantinos Imprialos1, Konstantinos Stavropoulos1

  • 1Department of Internal Medicine, Aristotle University , Thessaloniki, Greece.

Expert Opinion on Pharmacotherapy
|February 19, 2020
PubMed

Insights

Hypertension impacts about one-third of individuals with type 1 diabetes mellitus (T1DM), yet blood pressure control remains low. Treatment guidelines recommend lifestyle changes and antihypertensive therapy, targeting lower systolic blood pressure for better outcomes.

Area of Science:

  • Endocrinology
  • Cardiology
  • Nephrology

Background:

  • Type 1 diabetes mellitus (T1DM) is an autoimmune condition causing absolute insulin deficiency.
  • Hypertension is a frequent comorbidity in T1DM, contributing to cardiovascular disease and microvascular complications.

Purpose of the Study:

  • To review current definitions, epidemiology, and prevalence of hypertension in T1DM.
  • To outline contemporary therapeutic strategies for managing hypertension in T1DM patients.

Main Methods:

  • Literature review focusing on hypertension in T1DM.
  • Analysis of epidemiological data and prevalence rates.
  • Evaluation of current treatment guidelines and therapeutic options.

Main Results:

  • Approximately one-third of T1DM patients have hypertension, with higher rates in older individuals and those with longer disease duration.
  • Blood pressure control rates in T1DM patients with hypertension are notably low.
  • Treatment recommendations include lifestyle modifications and antihypertensive therapy, with specific targets for systolic blood pressure.

Conclusions:

  • Initiate antihypertensive treatment for T1DM patients with blood pressure above 140/90 mmHg, aiming for systolic pressure below 130 mmHg.
  • Consider lower systolic blood pressure targets (<130 mmHg) for T1DM patients with established cardiovascular disease or diabetic nephropathy.
  • Renin-angiotensin-aldosterone system inhibitors are recommended as initial pharmacotherapy; further research is needed on optimal treatment strategies.
Abstract

Keywords:
Angiotensin-converting enzyme inhibitorsSGLT2 inhibitorsangiotensin receptor blockershypertensionrenin-angiotensin-aldosterone system inhibitorstype 1 diabetes

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