The American Diabetes Association reports that nearly 2 in 3 people with diabetes say they take a prescription to lower their blood pressure. Thanks to updated guidelines reported by The Journal of the American Medical Association, the treatment of hypertension with medication may soon change for some patients.

New goals for adults over 60

The guidelines suggest adults over 60 years old should aim to have systolic blood pressure less than 150 (that’s the top number in your blood pressure reading) instead of the previous goal of less than 140. Evidence suggests that setting the goal less than 140 in this age group shows no additional benefit compared with the new goal of less than 150. Bringing high blood pressure to the goal of less than 150 reduces stroke, heart failure, and coronary heart disease.

Changes in drug regimen may not be necessary for older patients

The guidelines reveal that those over 60 years old, who are achieving the lower recommended blood pressure levels on their current medication without side effects, can stay on their treatment with no necessary adjustments.

Higher threshold for diabetics

Patients between 18 and 60 years old with diabetes or chronic kidney disease can aim for blood pressure of less than 140 instead of the previous target of less than 130.

More drug options

Expanded ranges of drugs are recommended to patients.

The recommendations for treating high blood pressure with medication vary by race. In the general nonblack population, including those with diabetes, initial treatments include:
• Thiazide-type diuretic
• Calcium channel blocker (CCB)
• Angiotensin-converting enzyme inhibitor (ACEI)
• Angiotensin receptor blocker (ARB).

In the general black population, including those with diabetes, the guidelines recommend that the initial antihypertensive treatment should include:
• Thiazide-type diuretic
• Calcium channel blocker (CCB)

Maintaining goal with medication

Using medication to reach and maintain goal blood pressure is the main objective of hypertension treatment. If your goal blood pressure is not met within a month of treatment on a single drug, your doctor may increase the initial drug dose or try adding a second drug from those mentioned above. If your goal cannot be reached with a second drug, a third drug from the list may be added. Your doctor will monitor and adjust the treatment until the goal blood pressure is reached.

Additional antihypertensive drugs can be used if the goal cannot be met by using the recommend drugs. Patients who can’t reach their goal blood pressure with the above methods may need to seek a hypertension specialist for additional consultation.

Exercise and diet

The guidelines highlight that the potential benefits of a healthy diet, regular exercise and a healthy weight cannot be overemphasized. Lifestyle changes have the potential to improve one’s blood pressure and even reduce the need for medication.

It’s important to note that the new guidelines have not redefined the numbers for high blood pressure, which is still set at 140/90. The recommendations are offered to doctors as an analysis about information regarding treatment thresholds, blood pressure goals and approaches to drug treatment.

These recommendations are intended for doctors, and are not a substitute for clinical judgment. The circumstances of each individual vary and patients should not stop taking medication until consulting their doctor.

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