Diabetes Standards of Care and Resources for Clinicians and Educators

Recommendations for Blood Pressure

Measurement and Monitoring

• Accurate measurement of blood pressure (BP) in the office setting requires calibrated and maintained equipment, regular retraining, and verification of proper technique for staff.* It is important to follow well-established procedures for measuring BP (See In-Office Measuring Blood Pressure Infographic Exit Disclaimer: You Are Leaving www.ihs.gov ).
• Measure BP at diabetes diagnosis and at every visit.
• Prescribe a home BP monitor. Encourage the patient to measure and record BP at different points in time, particularly following medication changes or before provider visits.**

* TARGET:BP Technique quick-check competency tool Exit Disclaimer: You Are Leaving www.ihs.gov  for health care staff from American Heart Association/American Medical Association

** Review guidance on the role of clinicians to support self-monitoring and provide patient feedback in Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians Exit Disclaimer: You Are Leaving www.ihs.gov  from Million Hearts®.

Hypertension Treatment Goals

The BP treatment target for most adults with diabetes and hypertension (HTN) is less than 130/80 mmHg. Treatment targets should be individualized and based on shared decision making (see Diabetes Treatment Algorithm: Hypertension Management in Type 2 Diabetes).

• Consider a higher BP target of <140/90 mmHg for patients with:
  • older age or frailty
  • multiple advanced comorbidities
  • polypharmacy
  • high risk for hypotension
  • burdensome side effects in achieving lower target
• Consider a lower BP target in patients with diabetes at risk for kidney disease progression (in patients with a urine albumin-to-creatinine ratio (UACR) ≥300 mg/g).

The BP treatment target for children and adolescents with diabetes and HTN varies with age.

• Adolescents aged 13 years and older- Target BP <130/80 mmHg
• Children aged less than 13 years- Target BP <90th percentile for gender, age, and height

Treatment of Elevated BP or HTN

BP greater than 120/80 mmHg

• Advise to limit salt intake (see Sodium Fact Sheet Exit Disclaimer: You Are Leaving www.ihs.gov  from Dietary Guidelines for Americans).
• Recommend a physical activity program to help patients maintain a healthy weight (aim for 150 minutes of moderate intensity exercise per week).
• Advise patients to limit alcohol intake (1 drink for women and 2 drinks for men per day).
• Provide tobacco cessation counseling and treatment.
• Encourage patients to get enough sleep (usually 7 to 9 hours for adults 18 – 64 years old, and 7 to 8 hours for adults aged 65 years and older).

BP greater than or equal to 130/80 mmHg

• Refer for medical nutrition therapy for instruction on dietary strategies to manage BP. Advise to limit sodium intake to no more than 2,300 mg per day (see the Dietary Approaches to Stop Hypertension [DASH] Eating Plan Exit Disclaimer: You Are Leaving www.ihs.gov  from the National Heart, Lung, and Blood Institute).
• Use medications to treat BP that is ≥130/80 mmHg on two or more occasions for people with diabetes (see the Diabetes Treatment Algorithm: Hypertension Therapy in Type 2 Diabetes from IHS Division of Diabetes Treatment and Prevention).

Featured Blood Pressure Resources

Organization	Resource
	Diabetes Treatment Algorithm: Hypertension Management in Type 2 Diabetes SDPI Healthy Heart Toolkit Recorded CME Webinars: Hypertension Guidelines
	2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71:e13-115. DOI: 10.1161/HYP0000000000000065 Exit Disclaimer: You Are Leaving www.ihs.gov  [PDF]
	American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes 2024 Exit Disclaimer: You Are Leaving www.ihs.gov  Diabetes Care 2024;47(Supplement_1):S179–S218 doi.org/10.2337/dc24-S010 American Diabetes Association. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes 2024 Exit Disclaimer: You Are Leaving www.ihs.gov  Diabetes Care 2024;47(Suppl_1):S219–S230. doi.org/10.2337/dc24-S011 American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes 2024 Exit Disclaimer: You Are Leaving www.ihs.gov  Diabetes Care 2024;47(Supplement_1):S258–S281. doi.org/10.2337/dc24-S014
	Hypertension Control Change Package (2nd Ed.) Exit Disclaimer: You Are Leaving www.ihs.gov  [PDF] Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians Exit Disclaimer: You Are Leaving www.ihs.gov  [PDF]
	Dietary Approaches to Stop Hypertension (DASH) Eating Plan Exit Disclaimer: You Are Leaving www.ihs.gov

Blood Pressure Patient Education Resources

Organization	Resource
	Online Catalog: Free Blood Pressure Resources Blood Pressure and Diabetes
	Learn & Prevent: Explore heart disease and stroke risks, consequences, and tips for prevention Exit Disclaimer: You Are Leaving www.ihs.gov
	High Blood Pressure Exit Disclaimer: You Are Leaving www.ihs.gov

Lipid Management CME Trainings

Session Title	Session Material	CME/CE Information
New CVD Risk Reduction for People with Diabetes- A Patient Centered Approach Exit Disclaimer: You Are Leaving www.ihs.gov  Lani Desaulniers, MD Clinical Consultant IHS Division of Diabetes (Originally presented on 07/26/23)	Slides [PDF – 4.6 MB]   Take Quiz	CE Information [PDF – 592 KB] Designated Credit Hours: 1.0 ACCME, ACPE, ANCC, CDR, CDE
Hypertension Guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  Dena Wilson, MD, FACC IHS Chief Clinical Consultant for Cardiology Chief Medical Officer, Phoenix Area IHS (Originally presented on 6/16/21.)	Slides [PDF – 1.6 MB]   Take Quiz	CE Information [PDF – 233 KB] Designated Credit Hours: 1.0 ACCME, ANCC, CDR, CERP