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Randomized clinical trials have demon-\nstrated unequivocally that treatment ofhypertension reduces cardiovascular events\nas well as microvascular complications\n(25–31). There has been controversy on\nthe recommendation of a specifi c blood\npressure goal in people with diabetes. The\ncommittee recognizes that there h... | [
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committee recognizes that there has been\nno randomized controlled trial to specifi -\ncally demonstrate a decreased incidenceof cardiovascular events in people with\ndiabetes by targeting a blood pressure\n<130/80 mmHg. The recommendation\nto support a blood pressure goal of<130/80 mmHg in people with diabetes is | [
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consistent with guidelines from the Ameri-can College of Cardiology and AmericanHeart Association (18), the InternationalSociety of Hypertension (19), and the Euro-\npean Society of Cardiology (20). The com-\nmittee ’s recommendation for the blood\npressure target of <130/80 mmHg derives\nprimarily from the collective ... | [
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primarily from the collective evidence of\nthe following randomized controlled trials.\nThe Systolic Blood Pressure Interven-tion Trial (SPRINT) demonstrated thattreatment to a target systolic blood\npressure of <120 mmHg decreases car-\ndiovascular event rates by 25% in high- | [
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diovascular event rates by 25% in high-\nrisk individuals, although people withdiabetes were excluded from this trial\n(32). The recently completed Strategy\nof Blood Pressure Intervention in theElderly Hypertensive Patients (STEP) trialincluded nearly 20% of people with dia-\nbetes and noted decreased cardiovascu- | [
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betes and noted decreased cardiovascu-\nlar events with treatment of hypertensionto a blood pressure target of <130 mmHg(33). While the ACCORD (Action to Control\nCardiovascular Risk in Diabetes) blood pres-sure trial (ACCORD BP) did not confi rm\nthat targeting a systolic blood pressure of<120 mmHg in people with diabe... | [
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sults in decreased cardiovascular eventrates, the prespeci fied secondary outcome\nof stroke was reduced by 41% with inten-sive treatment (34). The Action in Diabetes\nand Vascular Disease: Preterax and Diami-\ncron MR Controlled Evaluation (ADVANCE)\ntrial revealed that treatment with perindo-\npril/indapamide to an ac... | [
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pril/indapamide to an achieved systolic\nblood pressure of /C24135 mmHg signifi -\ncantly decreased cardiovascular event ratescompared with a placebo treatment with\nan achieved blood pressure of 140 mmHg(35). Therefore, it is recommended that\npeople with diabetes who have hyperten-sion should be treated to blood pres- | [
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sure targets of <130/80 mmHg. Notably,\nthere is an absence of high-quality dataavailable to guide blood pressure targets in\npeople with type 1 diabetes, but a similar\nblood pressure target of <130/80 mmHg\nis recommended in people with type 1diabetes. As discussed below, treatment\nshould be individualized, and trea... | [
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should be individualized, and treatment\nshould not be targeted to <120/80\nmmHg, as a mean achieved blood pressureof<120/80 mmHg is associated with ad-\nverse events.\nRandomized Controlled Trials of Intensive\nVersus Standard Blood Pressure Control\nSPRINT provides the strongest evidence to\nsupport lower blood press... | [
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support lower blood pressure goals in indi-\nviduals at increased cardiovascular risk, al-\nthough this trial excluded people with\ndiabetes (32). The trial enrolled 9,361 indi-\nviduals with a systolic blood pressure of$130 mmHg and increased cardiovascular\nrisk and treated to a systolic blood pressure\ntarget of <12... | [
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target of <120 mmHg (intensive treat-\nment) versus a target of <140 mmHg\n(standard treatment).The primary compos-\nite outcome of MI, coronary syndromes,\nstroke, heart failure, or death from cardio-\nvascular causes was reduced by 25% in the\nintensive treatment group. The achieved\nsystolic blood pressures in the t... | [
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systolic blood pressures in the trial were\n121 mmHg and 136 mmHg in the intensive\nversus standard treatment group, respec-\ntively. Adverse outcomes, including hypo-\ntension, syncope, electrolyte abnormality,\nand acute kidney injury (AKI), were more\ncommon in the intensive treatment arm; | [
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common in the intensive treatment arm;\nrisk of adverse outcomes needs to beweighed against the cardiovascular bene fit\nof more intensive blood pressure lowering.diabetesjournals.org/care Cardiovascular Disease and Risk Management S181\n©AmericanDiabetesAssociation | [
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ACCORD BP provides the strongest di-\nrect assessment of the bene fits and risks\nof intensive blood pressure control in peo-\nple with type 2 diabetes (34). In the study,a total of 4,733 individuals with type 2\ndiabetes were assigned to intensive ther-\napy (targeting a systolic blood pressure<120 mmHg) or standard th... | [
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ing a systolic blood pressure <140 mmHg).\nT h em e a na c h i e v e ds y s t o l i cb l o o dp r e s s u r e swere 119 mmHg and 133 mmHg in theintensive versus standard group, respec-tively. The primary composite outcome of\nnonfatal MI, nonfatal stroke, or death\nfrom cardiovascular causes was not signi fi- | [
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from cardiovascular causes was not signi fi-\ncantly reduced in the intensive treatmentgroup. The prespeci fied secondary out-\ncome of stroke was signifi cantly reduced\nby 41% in the intensive treatment group.Adverse events attributed to blood pres-sure treatment, including hypotension,syncope, bradycardia, hyperkalemia... | [
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elevations in serum creatinine, occurred\nmore frequently in the intensive treatmentarm than in the standard therapy arm(Table 10.1 ).\nOf note, the ACCORD BP and SPRINT tri-\nals targeted a similar systolic blood pressure<120 mmHg, but in contrast to SPRINT,\nthe primary composite cardiovascular endpoint was nonsigni ... | [
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ACCORD BP . The results have been inter-preted to be generally consistent betweenboth trials, but ACCORD BP was viewed asunderpowered due to the composite pri-mary end point being less sensitive to\nblood pressure regulation (32).\nThe more recent STEP trial assigned\n8,511 individuals aged 60 –80 years with\nhypertens... | [
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hypertension to a systolic blood pres-\nsure target of 110 to <130 mmHg (in-\ntensive treatment) or a target of 130 to<150 mmHg (33). In this trial, the primary\ncomposite outcome of stroke, acute cor-onary syndrome, acute decompensated\nheart failure, coronary revascularization,\natrial fibrillation, or death from card... | [
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atrial fibrillation, or death from cardio-\nvascular causes occurred in 3.5% of indi-viduals in the intensive treatment group\nversus 4.6% in the standard treatment\ngroup (hazard ratio [HR] 0.74 [95% CI0.60–0.92]; P= 0.007). In this trial,\n18.9% of individuals in the intensivetreatment arm and 19.4% in the stan-\ndard... | [
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dard treatment arm had a diagnosis of\ntype 2 diabetes. Hypotension occurredmore frequently in the intensive treat-ment group (3.4%) compared with the\nstandard treatment group (2.6%), with-\nout signi ficant differences in other adverseevents, including dizziness, syncope, orfractures.\nIn ADVANCE, 11,140 people with t... | [
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In ADVANCE, 11,140 people with type 2\ndiabetes were randomized to receive ei-ther treatment with a fixed combination\nof perindopril/indapamide or matchingp l a c e b o( 3 5 ) .T h ep r i m a r ye n dp o i n t ,acomposite of cardiovascular death, nonfa-tal stroke infarction, or worsening renal or\ndiabetic eye disease,... | [
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diabetic eye disease, was reduced by\n9% in the combination treatment. Theachieved systolic blood pressure was/C24135 mmHg in the treatment group and\n140 mmHg in the placebo group.\nThe Hypertension Optimal Treatment\n(HOT) trial enrolled 18,790 individualsand targeted diastolic blood pressure<90 mmHg, <85 mmHg, or <8... | [
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(36). The cardiovascular event rates, de-fined as fatal or nonfatal MI, fatal and\nnonfatal strokes, and all other cardio-vascular events, were not signi ficantly dif-\nferent between diastolic blood pressuretargets ( #90 mmHg, #85 mmHg, and\n#80 mmHg), although the lowest inci- | [
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#80 mmHg), although the lowest inci-\ndence of cardiovascular events occurredwith an achieved diastolic blood pressure\nof 82 mmHg. However, in people with dia-\nbetes, there was a signi ficant 51% reduc-\ntion in the treatment group with a targetdiastolic blood pressure of <80 mmHg\ncompared with a target diastolic blo... | [
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compared with a target diastolic bloodpressure of <90 mmHg.\nMeta-analyses of Trials\nTo clarify optimal blood pressure targetsin people with diabetes, multiple meta-\nanalyses have been performed. One\nof the largest meta-analyses included73,913 people with diabetes. Comparedwith a less tight blood pressure control, | [
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allocation to a tighter blood pressure\ncontrol signi ficantly reduced the risk of\nstroke by 31% but did not reduce therisk of MI (37). Another meta-analysis\nof 19 trials that included 44,989 individ-\nuals showed that a mean blood pres-sure of 133/76 mmHg is associated witha 14% risk reduction for major cardio-\nvasc... | [
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vascular events compared with a mean\nblood pressure of 140/81 mmHg (31).This bene fit was greatest in people with\ndiabetes. An analysis of trials including\npeople with type 2 diabetes and im-\npaired glucose tolerance with achievedsystolic blood pressures of <135 mmHg\nin the intensive blood pressure treat-ment group... | [
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in the intensive blood pressure treat-ment group and <140 mmHg in the\nstandard treatment group revealed a10% reduction in all-cause mortality anda 17% reduction in stroke (29). More in-tensive reduction to <130 mmHg was as-\nsociated with a further reduction in strokebut not other cardiovascular events.\nSeveral meta-... | [
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Several meta-analyses strati fied clinical\ntrials by mean baseline blood pressure ormean blood pressure attained in the in-tervention (or intensive treatment) arm.Based on these analyses, antihyperten-\nsive treatment appears to be most bene-\nficial when mean baseline blood pressure\nis$140/90 mmHg (17,25,26,28 –30). A... | [
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is$140/90 mmHg (17,25,26,28 –30). Among\ntrials with lower baseline or attained\nblood pressure, antihypertensive treat-\nment reduced the risk of stroke, reti-nopathy, and albuminuria, but effectson other ASCVD outcomes and heartfailure were not evident.\nIndividualization of Treatment Targets | [
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-... |
Individualization of Treatment Targets\nPeople with diabetes and clinicians shouldengage in a shared decision-making pro-cess to determine individual blood pressuretargets (17). This approach acknowledges\nthat the bene fits and risks of intensive\nblood pressure targets are uncertain and | [
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blood pressure targets are uncertain and\nmay vary across individuals and is consis-tent with a person-focused approach to\ncare that values individual priorities and\nhealth care professional judgment (38).Secondary analyses of ACCORD BP andS P R I N Ts u g g e s tt h a tc l i n i c a lf a c t o r sc a nh e l p | [
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determine individuals more likely to bene fit\nand less likely to be harmed by intensive\nblood pressure control (39,40).\nAbsolute bene fit from blood pressure\nreduction correlated with absolute base-\nline cardiovascular risk in SPRINT and in | [
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0.03507... |
line cardiovascular risk in SPRINT and in\nearlier clinical trials conducted at higherbaseline blood pressure levels (40,41). Ex-trapolation of these studies suggests that\npeople with diabetes may also be more\nlikely to benefi t from intensive blood pres-\nsure control when they have high absolutecardiovascular risk.T... | [
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tent with guidelines from the American\nCollege of Cardiology and American HeartAssociation, which also advocate a bloodpressure target of <130/80 mmHg for all\npeople, with or without diabetes (18).\nPotential adverse effects of antihy- | [
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Potential adverse effects of antihy-\npertensive therapy (e.g., hypotension,syncope, falls, AKI, and electrolyte abnor-malities) should also be taken into account\n(32,34,42,43). Individuals with older age, | [
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(32,34,42,43). Individuals with older age,\nC K D ,a n df r a i l t yh a v eb e e ns h o w nt ob ea thigher risk of adverse effects of intensiveblood pressure control (42). In addition, indi-\nviduals with orthostatic hypotension, sub- | [
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viduals with orthostatic hypotension, sub-\nstantial comorbidity, functional limitations,S182 Cardiovascular Disease and Risk Management Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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or polypharmacy may be at high risk of ad- | [
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verse effects, and some individuals mayprefer higher blood pressure targets to en-hance quality of life. However, ACCORD BPdemonstrated that intensive blood pres-sure lowering decreased the risk of cardio-vascular events irrespective of baselinediastolic blood pressure in individuals whoalso received standard glycemic ... | [
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whoalso received standard glycemic control(44).Therefore, the presence of low diastolic | [
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blood pressure is not necessarily a contrain-dication to more intensive blood pressuremanagement in the context of otherwisestandard care.\nPregnancy and Antihypertensive Medications\nThere are few randomized controlled trialsof antihypertensive therapy in pregnantindividuals with diabetes. A 2018 Cochrane | [
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systematic review of antihypertensive ther-apy for mild to moderate chronic hyper-tension included 63 trials and over 5,909w o m e na n ds u g g e s t e dt h a ta n t i h y p e r t e n -sive therapy probably reduces the risk ofdeveloping severe hypertension but maynot affect the risk of fetal or neonataldeath, small-fo... | [
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the risk of fetal or neonataldeath, small-for-gestational-age babies, orTable 10.1 —Randomized controlled trials of intensive versus standard hypertension treatment strategies | [
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Clinical trial Population Intensive Standard Outcomes\nACCORD BP (34) 4,733 participants with\nT2D aged 40 –79\nyears with prior\nevidence of CVD or\nmultiplecardiovascular risk\nfactorsSBP target:\n<120 mmHg\nAchieved (mean)\nSBP/DBP:\n119.3/64.4 mmHgSBP target:\n130–140 mmHg\nAchieved (mean)\nSBP/DBP:135/70.5 mmHg/C1... | [
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-... |
SBP/DBP:135/70.5 mmHg/C15No bene fit in primary end point:\ncomposite of nonfatal MI, nonfatalstroke, and CVD death\n/C15Stroke risk reduced 41% with\nintensive control, not sustainedthrough follow-up beyond the\nperiod of active treatment\n/C15Adverse events more common in\nintensive group, particularly\nelevated serum... | [
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0.00... |
intensive group, particularly\nelevated serum creatinine and\nelectrolyte abnormalities\nADVANCE (35) 11,140 participants\nwith T2D aged\n$55 years with\nprior evidence of\nCVD or multiple\ncardiovascular riskfactorsIntervention: a single-\npill,fixed-dose\ncombination ofperindopril and\nindapamide\nAchieved (mean)\nSBP... | [
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... |
combination ofperindopril and\nindapamide\nAchieved (mean)\nSBP/DBP:\n136/73 mmHgControl: placeboAchieved (mean)\nSBP/DBP:141.6/75.2 mmHg/C15Intervention reduced risk of primarycomposite end point of majormacrovascular and microvascularevents (9%), death from any cause\n(14%), and death from CVD (18%)\n/C156-year obser... | [
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... |
(14%), and death from CVD (18%)\n/C156-year observational follow-up\nfound reduction in risk of death inintervention group attenuated but\nstill signi ficant (310)\nHOT (36) 18,790 participants,\nincluding 1,501 withdiabetesDBP target:\n#80 mmHg\nAchieved (mean):\n81.1 mmHg, #80\ngroup; 85.2 mmHg,#90 groupDBP target: | [
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-0.0... |
Achieved (mean):\n81.1 mmHg, #80\ngroup; 85.2 mmHg,#90 groupDBP target:\n#90 mmHg/C15In the overall trial, there was no\ncardiovascular bene fit with more\nintensive targets\n/C15In the subpopulation with diabetes,\nan intensive DBP target was\nassociated with a signi ficantly\nreduced risk (51%) of CVD events\nSPRINT (4... | [
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-0.0172... |
reduced risk (51%) of CVD events\nSPRINT (42) 9,361 participants\nwithout diabetesSBP target:\n<120 mmHg\nAchieved (mean):\n121.4 mmHgSBP target:\n<140 mmHg\nAchieved (mean):\n136.2 mmHg/C15Intensive SBP target lowered risk of\nthe primary composite outcome\n25% (MI, ACS, stroke, heart failure,\nand death due to CVD)\n... | [
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0.02040933072566986,
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0.008895891718566418,
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and death due to CVD)\n/C15Intensive target reduced risk of\ndeath 27%\n/C15Intensive therapy increased risks of\nelectrolyte abnormalities and AKI\nSTEP (33) 8,511 participants aged\n60–80 years,\nincluding 1,627 withdiabetesSBP target:\n<130 mmHg\nAchieved (mean):\n127.5 mmHgSBP target:\n<150 mmHg\nAchieved (mean): | [
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Achieved (mean):\n127.5 mmHgSBP target:\n<150 mmHg\nAchieved (mean):\n135.3 mmHg/C15Intensive SBP target lowered risk of\nthe primary composite outcome\n26% (stroke, ACS [acute MI andhospitalization for unstable angina],\nacute decompensated heart failure,\ncoronary revascularization, atrialfibrillation, or death from\n... | [
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0.007630194071680307,
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cardiovascular causes)\n/C15Intensive target reduced risk of\ncardiovascular death 28%\n/C15Intensive therapy increased risks ofhypotension | [
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/C15Intensive therapy increased risks ofhypotension\nACCORD BP, Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial; ACS, acute coronary syndrome; ADVANCE, Action in Diabe-tes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation; AKI, acute kidney injury; CVD, cardiovascular disease;... | [
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-0.03647785261273384,
-0.0016... |
stolic blood pressure; HOT, Hypertension Optimal Treatment trial; MI, myocardial infarction; SBP, systolic blood pressure; SPRINT, Systolic | [
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Blood Pressure Intervention Trial; STEP, Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients; T2D, type 2 diabetes.diabetesjournals.org/care Cardiovascular Disease and Risk Management S183\n©AmericanDiabetesAssociation | [
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-0.05918072536587715,
-0.056... |
preterm birth (45). The Control of Hyper-\nt e n s i o ni nP r e g n a n c yS t u d y( C H I P S )( 4 6 )enrolled mostly women with chronic hyper-tension. In CHIPS, targeting a diastolic bloodpressure of 85 mmHg during pregnancy was\nassociated with reduced likelihood of devel- | [
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associated with reduced likelihood of devel-\noping accelerated maternal hypertensionand no demonstrable adverse outcome forinfants compared with targeting a higher di-\nastolic blood pressure. The mean systolic | [
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0.010846707969903946,
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0.01510035153478384,
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astolic blood pressure. The mean systolic\nb l o o dp r e s s u r ea c h i e v e di nt h em o r ei n t e n -sively treated group was 133.1 ± 0.5 mmHg,and the mean diastolic blood pressure\nachieved in that group was 85.3 ±\n0.3 mmHg. A similar approach is supportedby the International Society for the Study ofHypertensi... | [
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cally recommends use of antihypertensive\ntherapy to maintain systolic blood pres-\nsure between 110 and 140 mmHg and dia-stolic blood pressure between 80 and85 mmHg (47).\nThe more recent Chronic Hypertension | [
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... |
The more recent Chronic Hypertension\nand Pregnancy (CHAP) trial assignedpregnant individuals with mild chronichypertension to antihypertensive medi-cations to target a blood pressure goal\nof<140/90 mmHg (active treatment group)\nor to control treatment, in which antihyper- | [
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or to control treatment, in which antihyper-\ntensive therapy was withheld unless severehypertension (systolic pressure $160 mmHg\nor diastolic pressure $105 mmHg) devel-\noped (control group) (48). The primaryoutcome, a composite of preeclampsia withsevere features, medically indicated pretermbirth at <35 weeks of ges... | [
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0.03175739571452141,
-0.01626393012702465,
-0.08062536269426346,
-0.0... |
abruption, or fetal/neonatal death, occurredin 30.2% of female participants in the activetreatment group versus 37.0% in the controlgroup ( P<0.001). The mean systolic blood\npressure between randomization and deliv-ery was 129.5 mmHg in the active treat-ment group and 132.6 mmHg in the controlgroup.\nCurrent evidence ... | [
-0.005116963293403387,
-0.03748588636517525,
-0.07124478369951248,
0.026138871908187866,
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0.024972068145871162,
0.012602293863892555,
0.13129101693630219,
0.036494530737400055,
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0.07209068536758423,
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-0.0... |
Current evidence supports controlling\nblood pressure to 110 –135/85 mmHg to\nreduce the risk of accelerated maternal hy-pertension but also to minimize impair-ment of fetal growth. During pregnancy,\ntreatment with ACE inhibitors, angiotensin | [
-0.047524161636829376,
0.03886115550994873,
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0.031638629734516144,
0.05501298978924751,
0.03187049925327301,
-0.05932415649294853,
0.06081710755825043,
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0.012414779514074326,
0.01434729527682066,
-0.03827482834458351,
-0.03387707471847534,
-0.05975... |
treatment with ACE inhibitors, angiotensin\nreceptor blockers (ARBs), direct renin in-hibitors, and spironolactone are contrain-dicated, as they may cause fetal damage.Special consideration should be taken for\nindividuals of childbearing potential, and | [
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individuals of childbearing potential, and\npeople intending to become pregnantshould switch from an ACE inhibitor/ARB or spironolactone to an alternative an-\ntihypertensive medication approved during\npregnancy. Antihypertensive drugs knownto be effective and safe in pregnancy in- | [
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clude methyldopa, labetalol, and long-acting nifedipine, while hydralazine may beconsidered in the acute management ofhypertension in pregnancy or severe pre-eclampsia (49). Diuretics are not recom-mended for blood pressure control inpregnancy but may be used during late-stage pregnancy if needed for volume con- | [
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... |
trol (49,50). The American College of\nObstetricians and Gynecologists also rec-ommends that postpartum individualswith gestational hypertension, preeclamp-sia, and superimposed preeclampsia havetheir blood pressures observed for 72 h inthe hospital and 7 –10 days postpartum.\nLong-term follow-up is recommendedfor thes... | [
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-0... |
creased lifetime cardiovascular risk\n(51). See Section 15, “Management of\nDiabetes in Pregnancy, ”for additional\ninformation.\nTreatment Strategies\nLifestyle Intervention\nRecommendation\n10.6 For people with blood pressure\n>120/80 mmHg, lifestyle interven-\ntion consists of weight loss when | [
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-0.07... |
>120/80 mmHg, lifestyle interven-\ntion consists of weight loss when\nindicated, a Dietary Approaches toStop Hypertension (DASH) –style eat-\ning pattern including reducing sodiumand increasing potassium intake, mod-eration of alcohol intake, smoking ces-sation, and increased physical activity. A\nLifestyle management ... | [
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-0.0060000913217663765,
0.03294071555137634,
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0.08234231173992157,
-0.08167518675327301,
0.00011381417425582185,
-... |
Lifestyle management is an important\ncomponent of hypertension treatment be- | [
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cause it lowers blood pressure, enhancesthe effectiveness of some antihypertensivemedications, promotes other aspects ofmetabolic and vascular health, and gener-ally leads to few adverse effects. Lifestyletherapy consists of reducing excess bodyweight through caloric restriction (see Sec-tion 8, “Obesity and Weight Man... | [
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for the Prevention and Treatment ofType 2 Diabetes ”), at least 150 min of mod-\nerate-intensity aerobic activity per week(see Section 3, “Prevention or Delay of\nDiabetes and Associated Comorbidities ”), re-\nstricting sodium intake ( <2,300 mg/day),\nincreasing consumption of fruits and veg-etables (8 –10 servings pe... | [
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dairy products (2 –3s e r v i n g sp e rd a y ) ,\navoiding excessive alcohol consumption(no more than 2 servings per day in menand no more than 1 serving per day inwomen) (52), and increasing activity lev-\nels (53) (see Section 5, “Facilitating\nPositive Health Behaviors and Well-beingto Improve Health Outcomes ”). | [
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0.05060262233018875,
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These lifestyle interventions are reason-\nable for individuals with diabetes and\nmildly elevated blood pressure (systolic\n>120 mmHg or diastolic >80 mmHg) and\nshould be initiated along with pharmaco-logic therapy when hypertension is diag-\nnosed (Fig. 10.2) (53). A lifestyle therapy | [
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nosed (Fig. 10.2) (53). A lifestyle therapy\nplan should be developed in collaborationwith the person with diabetes and dis-cussed as part of diabetes management.\nUse of internet or mobile-based digital\nplatforms to reinforce healthy behaviors\nmay be considered as a component of | [
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0.055... |
may be considered as a component of\ncare, as these interventions have beenfound to enhance the ef ficacy of medical\ntherapy for hypertension (54,55).\nPharmacologic Interventions\nRecommendations\n10.7 Individuals with confi rmed of fice-\nbased blood pressure $130/80 mmHg\nqualify for initiation and titration of | [
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qualify for initiation and titration of\npharmacologic therapy to achieve therecommended blood pressure goal of\n<130/80 mmHg. A\n10.8 Individuals with confi rmed offi ce-\nbased blood pressure $150/90 mmHg\nshould, in addition to lifestyle therapy,\nhave prompt initiation and timely titra-\ntion of two drugs or a single... | [
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0.08063312619924545,
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0.04474446550011635,
0.02834... |
tion of two drugs or a single-pill com-\nbination of drugs demonstrated toreduce cardiovascular events in peoplewith diabetes. A\n10.9 Treatment for hypertension should\ninclude drug classes demonstrated toreduce cardiovascular events in peoplewith diabetes. AACE inhibitors or an- | [
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0.0762134... |
giotensin receptor blockers (ARBs) arerecommended first-line therapy for hy-\npertension in people with diabetes andcoronary artery disease. A\n10.10 Multiple-drug therapy is gener-\nally required to achieve blood pres-sure targets. However, combinationsof ACE inhibitors and ARBs and com-\nbinations of ACE inhibitors or... | [
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0.... |
binations of ACE inhibitors or ARBs\n(including ARBs/neprilysin inhibitors)with direct renin inhibitors should notbe used. A\n10.11 An ACE inhibitor or ARB, at the\nmaximum tolerated dose indicated forblood pressure treatment, is the recom-mended first-line treatment for hyperten- | [
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sion in people with diabetes and urinaryalbumin-to-creatinine ratio $300 mg/gS184 Cardiovascular Disease and Risk Management Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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0.0... |
creatinine Aor 30 –299 mg/g creatinine. B\nIf one class is not tolerated, the other\nshould be substituted. B\n10.12 For adults treated with an ACE\ninhibitor, ARB, mineralocorticoid recep-t o ra n t a g o n i s t( M R A ) ,o rd i u r e t i c ,s e r u mcreatinine/estimated glomerular filtra- | [
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0.002568558556959033,
0.08207002282142639,
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tion rate and serum potassium levelsshould be monitored within 7 –14 days\nafter initiation of therapy and at least\nannually. B\nInitial Number of Antihypertensive Medi-\ncations. Initial treatment for people with\ndiabetes depends on the severity of hyper-\ntension ( Fig. 10.2 ). Those with bloodpressure between 130/... | [
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0.028672536835074425,
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90 mmHg may begin with a single drug.\nFor individuals with blood pressure $150/\n90 mmHg, initial pharmacologic treat-\nment with two antihypertensive medica-\ntions is recommended in order to moreeffectively achieve adequate blood pres-\nsure control (56 –58). Single-pill antihy- | [
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sure control (56 –58). Single-pill antihy-\npertensive combinations may improveRecommendations for the Treatment of Confirmed\nHypertension in Nonpregnant People With Diabetes\nInitial BP ≥ 130/80 and\n<150/90 mmHg\nAlbuminuria or CAD *\nNo No Yes YesAlbuminuria or CAD *Initial BP ≥ 150/90 mmHg\nStart one agent\nContin... | [
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Start one agent\nContinue therapy\nContinue therapyLifestyle management Start two agents\nAssess BP Control and Adverse Effects\nAssess BP Control and Adverse Effects\nConsider Addition of Mineralocorticoid Receptor Antagonist;\nRefer to Specialist With Expertise in BP ManagementStart:\nACEi or ARB\nand\nCCB† or Diuret... | [
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0.06547152251005173,
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0.09334508329629898,
-0.04627569019794464,
-0.05582461878657341,
-0.03318354859948158,
-0.059606362134218216,
-0.03242998942732811,
0.029901... |
ACEi or ARB\nand\nCCB† or Diuretic ‡\nTreatment tolerated\nand target achieved\nNot meeting target\non two agents\nTreatment tolerated\nand target achievedAdverse\neffectsNot meeting target Adverse effects\nNot meeting target or\nadverse effects using a drug\nfrom each of three classesStart one drug:\nACEi or ARB\nCCB†... | [
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-0.01594471000134945,
0.004305723123252392,
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0.03940563276410103,
0.08230192959308624,
0.000859864812809974,
-0.03511277958750725,
0.025636417791247368,
-0.012978163547813892,
-0.009754963219165802,
0.009... |
ACEi or ARB\nCCB†\nDiuretic ‡Start:\nACEi or ARBStart drug from\n2 of 3 options:\nACEi or ARB\nCCB†\nDiuretic ‡\nAdd agent from\ncomplementary drug class:\nACEi or ARB\nCCB†\nDiuretic ‡Consider change toalternative medication:\nACEi or ARB\nCCB†\nDiuretic ‡REASSESS \nREGULARLY \n(3-6 MONTHS) | [
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-0.05514907464385033,
0.033022958785295486,
0.011327637359499931,
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... |
ACEi or ARB\nCCB†\nDiuretic ‡REASSESS \nREGULARLY \n(3-6 MONTHS)\nFigure 10.2— Recommendations for the treatment of con firmed hypertension in nonpregnant people with diabetes. *An ACE inhibitor (ACEi) or an-\ngiotensin receptor blocker (ARB) is suggested to treat hypertension for people with coronary artery disease (CA... | [
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-0.... |
ratio 30 –299 mg/g creatinine and strongly recommended for individuals with urine albumin-to-creatinine ratio $300 mg/g creatinine.\n†Dihydropyridine calcium channel blocker (CCB). ‡Thiazide-like diuretic; long-acting agents shown to reduce cardiovascular events, such as chlor- | [
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-0.10153418779373169,
-0.034101199358701706,
0.06... |
thalidone and indapamide, are preferred. BP, blood pressure. Adapted from de Boer et al. (18).diabetesjournals.org/care Cardiovascular Disease and Risk Management S185\n©AmericanDiabetesAssociation | [
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medication taking in some individuals\n(59).\nClasses of Antihypertensive Medications.\nInitial treatment for hypertension should in-clude any of the drug classes demonstratedto reduce cardiovascular events in peoplewith diabetes: ACE inhibitors (60,61), ARBs\n(60,61), thiazide-like diuretics (62), or dihy- | [
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0.04405316710472107,
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0.0208927... |
(60,61), thiazide-like diuretics (62), or dihy-\ndropyridine calcium channel blockers (63).In people with diabetes and establishedcoronary artery disease, ACE inhibitors orARBs are recommended first-line therapy\nfor hypertension (64 –66). For individu-\nals with albuminuria (urine albumin-to-creatinine ratio [UACR] $30... | [
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0.0216... |
initial treatment should include an ACEinhibitor or ARB to reduce the risk of pro-gressive kidney disease (18) ( Fig. 10.2). In in-\ndividuals receiving ACE inhibitor or ARBtherapy, continuation of those medicationsas kidney function declines to estimated glo-merular filtration rate (eGFR) <30 mL/min/\n1.73 m\n2may prov... | [
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-0.03134268894791603,
... |
1.73 m\n2may provide cardiovascular bene fit\nwithout signifi cantly increasing the risk of | [
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0.01... |
without signifi cantly increasing the risk of\nend-stage kidney disease (67). In the ab-sence of albuminuria, risk of progressivekidney disease is low, and ACE inhibitorsand ARBs have not been found to affordsuperior cardioprotection compared withthiazide-like diuretics or dihydropyridinecalcium channel blockers (68). b... | [
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0.06014653295278549,
-0.012897878885269165,
... |
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