Rozpoznanie i leczenie nadciśnienia tętniczego u pacjentów ze współistniejącą cukrzycą w świetle zmieniających się wytycznych

Abstract

Hypertension and diabetes are, after smoking, obesity and hypercholesterolemia, the most important cardiovascular risk factors. It is common for these diseases to coexist, which leads to a poorer prognosis. There are differing medical association guidelines regarding the values of blood pressure when treatment should start, but instructions are consistent with the goals of treatment for diabetic patients. The guidelines published in 2017 by the American College of Cardiology/American Heart Association (ACC/AHA) suggest a value of 130/80 mm Hg for both diagnosis and starting treatment. The European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines published in 2018 recommend a value of 140/90 mm Hg when we should start therapy, with the goal of treatment below 130/80 mm Hg, but only if drug tolerance is good. The exception is patients aged over 65, for whom we should maintain systolic blood pressure in the range 130–140 mm Hg. The new Polish 2019 guidelines from the Polish Diabetology Association (PTD, Polskie Towarzystwo Diabetologiczne ) and the Polish Society of Hypertension (PTNT, Polskie Towarzystwo Nadciśnienia Tetniczego ) have been adjusted to align with the ESC/ESH guidelines. In this article, we look at changes in the guidelines over the last 20 years. We also look back at the clinical trials which have had the biggest impact on the guidelines. We describe the optimal treatment of hypertension in diabetic patients. Among all the hypotensive drugs recommended as a first choice are angiotensin-converting enzyme inhibitors or angiotensin AT 1 receptor blockers, together with calcium channel blockers and/or diuretics. There is increasing evidence regarding the positive influence of diabetic drugs on blood pressure, especially sodium-glucose cotransporter 2 inhibitors.