Diabetes Standards of Care and Resources for Clinicians and Educators
Blood pressure (BP) control in people with diabetes is essential to reduce the risk of diabetes complications, including heart attack, stroke, heart failure, retinopathy, and kidney disease. Hypertension (HTN) or high BP is defined as a systolic BP greater than or equal to 130 mmHg or a diastolic BP greater than or equal to 80 mmHg. Hypertension in people with diabetes is common and often requires multiple medications to achieve targeted goals.
Clinical Practice Recommendations
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.**
** 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
- 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).
Clinician and Educator Resources
Featured Blood Pressure Resources
Patient Education Resources
Blood Pressure Patient Education Resources
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.govLani Desaulniers, MD
IHS Division of Diabetes
(Originally presented on 07/26/23)
|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.)