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lines. Notably, the majority of evidence\nsupporting interventions to reduce car-diovascular risk in diabetes comes fromtrials of people with type 2 diabetes. Norandomized trials have been speci fically | [
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designed to assess the impact of cardio-vascular risk reduction strategies in peo-ple with type 1 diabetes. Therefore, therecommendations for cardiovascular riskfactor modi fication for people with type 1\ndiabetes are extrapolated from data ob-\ntained in people with type 2 diabetes\nand are similar to those for people... | [
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and are similar to those for people with\ntype 2 diabetes.\nAs depicted in Fig. 10.1 ,ac o m p r e h e n -\nsive approach to the reduction in risk ofdiabetes-related complications is recom-mended. Therapy that includes multiple,\nconcurrent evidence-based approaches | [
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concurrent evidence-based approaches\nto care will provide complementary re-d u c t i o ni nt h er i s k so fm i c r o v a s c u l a r\noutcomes, including kidney, retinopathy,\nneurologic, and cardiovascular complica-\ntions. Management of glycemia, blood\npressure, and lipids and the incorpora-tion of speci fic therap... | [
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cular and kidney outcomes benefi t( a s\nindividually appropriate) are consideredfundamental elements of global risk re-\nduction in diabetes.\nTHE RISK CALCULATOR\nThe American College of Cardiology\nASCVD risk calculator (Risk Estimator Plus)is generally a useful tool to estimate\n10-year risk of a first ASCVD event | [
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10-year risk of a first ASCVD event\n(available online at tools.acc.org/ASCVD-Risk-Estimator-Plus). The calculator was\ndeveloped to stratify cardiovascular riskand identify those people who will bene fitmost from statin therapy and from treat- | [
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ment with antihypertensive medications(16). The calculator includes diabetes as arisk factor, since diabetes itself confers in-\ncreased risk for ASCVD, although it should\nbe acknowledged that these risk calcula-tors do not account for the duration ofdiabetes or the presence of diabetes com-\nplications, such as album... | [
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plications, such as albuminuria. In addition,\nthe majority of people with diabetes shouldbe treated with statin therapy, and hyper-tension should be promptly treated. As\nwe will discuss below, comprehensive\nmanagement of hypertension, hyperlip-idemia, and hyperglycemia using man-\nagement approaches with established | [
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agement approaches with established\nbene fit are important strategies to re-\nduce cardiovascular risk.\nHYPERTENSION/BLOOD PRESSURE\nCONTROL\nAn elevated blood pressure is defi ned as\na systolic blood pressure 120 –129 mmHg\nand a diastolic blood pressure <80 mmHg\n(17). Hypertension is de fined as a systolic\nblood pr... | [
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blood pressure $130 mmHg or a diastolic\nblood pressure $80 mmHg (17). This is in\nagreement with the de finition of hyper-\ntension by the American College of Cardi-\nology and American Heart Association\n(17). Hypertension is common among\npeople with either type 1 or type 2 diabe-tes. Hypertension is a major risk fac... | [
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ASCVD, heart failure, and microvascular\ncomplications. Moreover, numerous studieshave shown that antihypertensive therapyreduces ASCVD events, heart failure,\nand microvascular complications. Please\nrefer to the ADA position statement“Diabetes and Hypertension ”for a de-\ntailed review of the epidemiology, diag-\nnos... | [
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nosis, and treatment of hypertension\n(18) and recent updated hypertensionguideline recommendations (17,19,20).\nScreening and Diagnosis\nRecommendations\n10.1 Blood pressure should be mea-\nsured at every routine clinical visit.\nWhen possible, individuals found tohave elevated blood pressure (systolicblood pressure 1... | [
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diastolic <80 mmHg) should have blood\npressure con firmed using multiple read-\nings, including measurements on a sepa-\nrate day, to diagnose hypertension. A\nHypertension is de fined as a systolic\nblood pressure $1 3 0m m H go rad i a -\nstolic blood pressure $80 mmHg based | [
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stolic blood pressure $80 mmHg based\nFigure 10.1— Multifactorial approach to reduction in risk of diabetes complications. *Risk re-\nduction interventions to be applied as individually appropriate.S180 Cardiovascular Disease and Risk Management Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAsso... | [
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on an average of two or more meas-\nurements obtained on two or more\noccasions. AIndividuals with blood\npressure $1 8 0 / 1 1 0m m H ga n dc a r -\ndiovascular disease could be diag-nosed with hypertension at a singlevisit. E\n10.2 All people with hypertension | [
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10.2 All people with hypertension\nand diabetes should be counseled tomonitor their blood pressure at homeafter appropriate education. A\nBlood pressure should be measured at ev- | [
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Blood pressure should be measured at ev-\nery routine clinical visit by a trained indi-vidual and should follow the guidelinesestablished for the general population:measurement in the seated position, withfeet on the floor and arm supported at | [
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heart level, after 5 min of rest. Cuffsize should be appropriate for the up-per-arm circumference (21). Elevatedvalues should preferably be con firmed\non a separate day; however, in indivi-duals with cardiovascular disease andblood pressure $180/110 mmHg, it is | [
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reasonable to diagnose hypertension ata single visit (19). Postural changes inblood pressure and pulse may be evi-dence of autonomic neuropathy andtherefore require adjustment of bloodpressure targets. Orthostatic blood pres-sure measurements should be checkedon initial visit and as indicated.\nHome blood pressure self... | [
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Home blood pressure self-monitoring\na n d2 4 - ha m b u l a t o r yb l o o dp r e s s u r em o n -itoring may provide evidence of whitecoat hypertension, masked hypertension,or other discrepancies between offi ce and\n“true”blood pressure (22,23). In addition\nto con firming or refuting a diagnosis of | [
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to con firming or refuting a diagnosis of\nhypertension, home blood pressure assess-m e n tm a yb eu s e f u lt om o n i t o ra n t i h y p e r -tensive treatment. Studies of individualswithout diabetes found that home meas-urements may better correlate with ASCVDrisk than of fice measurements (22,23). | [
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Moreover, home blood pressure monitor-ing may improve medication-taking behav-ior and thus help reduce cardiovascularrisk (24).\nTreatment Goals\nRecommendations\n10.3For people with diabetes and hyper- | [
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Recommendations\n10.3For people with diabetes and hyper-\ntension, blood pressure targets shouldbe individualized through a shared deci-sion-making process that addresses car-diovascular risk, potential adverse effectsof antihypertensive medications, and in-\ndividual preferences. B\n10.4 The on-treatment target blood\... | [
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10.4 The on-treatment target blood\npressure goal is <130/80 mmHg, if\nit can be safely attained. A\n10.5 In pregnant individuals with dia-\nbetes and chronic hypertension, a bloodpressure threshold of 140/90 mmHg for\ninitiation or titration of therapy is associ-\nated with better pregnancy outcomesthan reserving trea... | [
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pertension, with no increase in risk of\nsmall-for-gestational-age birth weight. A\nThere are limited data on the opti-mal lower limit, but therapy should\nbe deintensi fied for blood pressure\n<90/60 mmHg. EA blood pressure tar-\nget of 110 –135/85 mmHg is suggested\nin the interest of reducing the risk foraccelerated ... | [
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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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0.020026... |
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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0.028127819299697876,
0.028163190931081772,
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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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0.021298138424754143,
-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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0.05551730841398239,
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0.008895891718566418,
-0.0307756420224905,
-0.03... |
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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-0.00... |
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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0.02125113271176815,
-0.01960700750350952,
0.0103002255782485,
-0.005479434505105019,
0.03394193947315216,
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0.1946679800748825,
0.0016646736767143011,
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0.007630194071680307,
-0.009003554470837116,
-0.014096802100539207,
-0.035... |
cardiovascular causes)\n/C15Intensive target reduced risk of\ncardiovascular death 28%\n/C15Intensive therapy increased risks ofhypotension | [
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0.034901995211839676,
0.025835545733571053,
0.052053146064281464,
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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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0.012554147280752659,
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-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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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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0.041336823254823685,
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0.03321418538689613,
-0.009036118164658546,
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-0... |
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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-0.0... |
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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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 ... | [
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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 | [
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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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0.032284777611494064,
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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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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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>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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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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