Management of hypertension in the cardiometabolic syndrome and diabetes

Abstract

This article reviews the goals of antihypertensive therapy in patients with the cardiometabolic syndrome, as well as diabetes in the context of reducing progression of kidney disease and decreasing cardiovascular (CV) mortality. All published guidelines recommend a blood pressure (BP) goal of less than 130/80 mm Hg in people with diabetes. To achieve this BP, an average of three different antihypertensive agents, appropriately dosed, are needed. Initial therapy includes an inhibitor of the renin-angiotensin-aldosterone system usually coupled with a thiazide diuretic. Beta-Blockers are often employed to both lower BP and reduce overall CV risk; however, nondihydropyridine calcium antagonists are comparable in benefit without the adverse metabolic effects. Changing lifestyle patterns to include exercise and proper diet, achieving target BP and lipid goals, and treating with an aspirin daily reduces the absolute risk of a CV event by 20% over less intensive treatment. Thus, treating the cardiometabolic syndrome requires an aggressive approach with a focus on both lifestyle modification and pharmacologic intervention.