CVD is the major cause of mortality for individuals with diabetes. It is also a major contributor to morbidity and direct and indirect costs of diabetes. Type 2 diabetes is an independent risk factor for macrovascular disease, and its common coexisting conditions (e.g., hypertension and dyslipidemia) are also risk factors.
Studies have shown the efficacy of reducing cardiovascular risk factors in preventing or slowing CVD. Evidence is summarized in the following sections and reviewed in detail in the ADA technical reviews on hypertension, dyslipidemia , aspirin therapy , and smoking cessation and the consensus statement on CHD in people with diabetes. Emphasis should be placed on reducing cardiovascular risk factors, when possible, and clinicians should be alert for signs and symptoms of atherosclerosis.
1. Hypertension/blood pressure control
Recommendations
Screening and diagnosis
* Blood pressure should be measured at every routine diabetes visit. Patients found to have systolic blood pressure 130 mmHg or diastolic blood pressure 80 mmHg should have blood pressure confirmed on a separate day. (C)
Goals
* Patients with diabetes should be treated to a systolic blood pressure <130 mmHg. (C)
* Patients with diabetes should be treated to a diastolic blood pressure <80 mmHg. (B)
Treatment
* Patients with hypertension (systolic blood pressure 140 or diastolic blood pressure 90 mmHg) should receive drug therapy in addition to lifestyle and behavioral therapy. (A)
* Multiple drug therapy (two or more agents at proper doses) is generally required to achieve blood pressure targets. (B)
* Patients with a systolic blood pressure of 130??macroalbuminuria. (A)
” In those with type 2 diabetes, hypertension, macroalbuminuria, and renal insufficiency, ARBs have been shown to delay the progression of nephropathy. (A)
* In pregnant patients with diabetes and chronic hypertension, blood pressure target goals of 110??tic β-cell function and prevention of type 2 diabetes by pharmacological trewatment of insulin resistance in high-risk hispanic women. Diabetes 51:2796 -2803, 2002
12. Engelgau ME, Narayan KMV, Herman WH: Screening for type 2 diabetes (Technical Review). Diabetes Care 23:1563-1580, 2000 [erratum appears in Diabetes Care 23:1868 -1869, 2000]
13. American Diabetes Association: Type 2 diabetes in children and adolescents (Consensus Statement). Diabetes Care 23:381-389, 2000
14. American Diabetes Association: Gestational diabetes mellitus (Position Statement). Diabetes Care 27 (Suppl. 1):S88 – S90, 2004
15. The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 329: 977-986, 1993
16. The UK Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837- 853, 1998
17. The UK Prospective Diabetes Study Group: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352:854 -865, 1998
