ECE2015 Symposia Management of type 2 diabetes: State of the art (3 abstracts)
1Steno Diabetes Center, Gentofte, Denmark; 2NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark; 3Health Aarhus University, Aarhus, Denmark.
Hypertension is a major risk factor in type 2 diabetes both for cardiovascular and microvascular complications. It has been estimated that hypertension contributes to 41% of the attributable risk for mortality. Proper assessment of blood pressure, consideration of diurnal pattern, white coat and masked hypertension is important. Lifestyle factors should be addressed in the management, but in most patients pharmaceutical intervention is needed. The optimal intervention usually requires a combination of agents, particularly in patients with hypertension and renal complications, where three antihypertensive agents on average are used. Therefore selection of the optimal combination with best effect and least side effects are important, which requires attention to individual factors such as renal complications, history of cardiovascular events, fluid balance and electrolyte status. In addition attention to occurrence of side effects, as well as adherence to treatment regimen is important factors. Here consideration of the multifactorial intervention applied in type 2 diabetes is important. It is always a matter of discussion when to start treatment, as well as target blood pressure for treated individuals. Although targets have been declining for decades, to 130/80 mmHg, many of the most recent guidelines suggest a higher target blood pressure, such as 140/90, and probably as for glucose management, a need for a more individualised approach both regarding onset of treatment and target. This debate is fuelled by lack of clear evidence for the optimal target. Finally antihypertensive agents may play an important role in preventing the microvascular complications even in normotensive subjects.