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Updated Assessment and Treatment of Diabetes with Hypertension

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Dr Rajiv Agarwal, New Delhi    04 January 2018

It is imperative that doctors and patients stay abreast of the most current care recommendations that can lead to improved cardiovascular health for people with diabetes and will ultimately result in better overall health.

Latest updated assessment and treatment of hypertension among people with diabetes, including advances in care, a position statement by the ADA recommend a lower BP target of <130/80 mmHg in patients with a high risk of cardiovascular disease. The updated recommendations are based on review of 137 clinical trials and meta-analyses including ACCORD BP, ADVANCE BP, HOT and SPRINT trials.

The report “strongly recommends” that home BP monitoring be carried out by all hypertensive patients with diabetes with periodic reporting. New recommendations provide lifestyle management plans for lowering BP that include suggestions for weight loss, a Dietary Approaches to Stop Hypertension (DASH)-style food plan and increased physical activity.

The new ADA 2017 treatment of hypertension in patients with diabetes guideline recommends <130/80 mmHg BP goal for patients with diabetes at high risk of cardiovascular disease. This recommendation further strengthens the use of azilsartan in T2DM with high risk of cardiovascular disease.

Azilsartan is the latest approved ARB, and it has shown its superiority in terms of efficacy, safety and metabolic effects compared to other ARBs in patients with prediabetes and T2DM in a pooled analysis of over 3,800 patients in randomized controlled trials. Evidence suggests that azilsartan exhibits greater BP-lowering effect than valsartan and olmesartan. Data also suggest its beneficial antidiabetic and cardioprotective properties. It is more potent than most other ARBs for inhibiting binding of angiotensin II to human AT1 receptor membrane preparations, and reduces 24-hour BP in hypertensive patients without serious comorbidities more effectively than maximum approved doses of the well-known ARBs olmesartan, valsartan and candesartan.

Azilsartan, thus represents the future of hypertension management in patients with diabetes.

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