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Gouni-Berthold, Ioanna, Hanssen, Ruth, Ravarani, Lisa and Berthold, Heiner K. (2017). Management of Blood Pressure and Heart Rate in Patients with Diabetes Mellitus. Curr. Pharm. Design, 23 (31). S. 4573 - 4583. SHARJAH: BENTHAM SCIENCE PUBL LTD. ISSN 1873-4286

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Abstract

Background: In patients with diabetes mellitus (DM) there is a clear association between blood pressure (BP) levels and macrovascular and microvascular complications. However, the BP targets that need to be achieved for optimal outcomes remain controversial. Methods: The purpose of this narrative review is to discuss BP targets and management in patients with DM. The subject of elevated heart rate, which has been associated with mortality in many populations, and which is observed in some patients with DM will also be addressed. Results: Most guidelines recommend a target BP in patients with DM of <140/90 mmHg. Most consistently recommended first-line pharmacotherapy for the treatment of hypertension in non-black patients with DM is an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) while for black patients a calcium channel blocker or a thiazide diuretic. Newer antidiabetic drugs, such as the glucagon-like peptide-1 (GLP-1) receptor agonists and the sodium glucose co-transporter-2 (SGLT2) inhibitors lower not only blood glucose but also BP levels. The SGLT2 inhibitor-associated decrease in BP is not accompanied by an increase in heart rate, which is observed however with GLP-1 receptor agonists. Conclusion: The most widely accepted BP target for patients with DM among guidelines is <140/90 mmHg and the most widely accepted pharmacotherapy to achieve these goals are ACE inhibitors and ARBs. Newer antidiabetic medications have been shown to also lower BP and decrease cardiovascular events, thus representing a promising new therapeutic option for patients with DM and hypertension.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gouni-Berthold, Ioanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Hanssen, Ruth UNSPECIFIED UNSPECIFIED UNSPECIFIED Ravarani, Lisa UNSPECIFIED UNSPECIFIED UNSPECIFIED Berthold, Heiner K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-244822
DOI:	10.2174/1381612823666170609084436
Journal or Publication Title:	Curr. Pharm. Design
Volume:	23
Number:	31
Page Range:	S. 4573 - 4583
Date:	2017
Publisher:	BENTHAM SCIENCE PUBL LTD
Place of Publication:	SHARJAH
ISSN:	1873-4286
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CORONARY-ARTERY-DISEASE; GLP-1 RECEPTOR AGONISTS; CARDIOVASCULAR AUTONOMIC NEUROPATHY; COTRANSPORTER 2 INHIBITORS; DOUBLE-BLIND; OPEN-LABEL; HYPERTENSIVE PATIENTS; MICROVASCULAR OUTCOMES; INTERNATIONAL-SOCIETY; INSULIN GLARGINE Multiple languages Pharmacology & Pharmacy Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24482