Managing blood pressure in

type 2 diabetes
A NICE pathway brings together all NICE guidance, quality
standards and materials to support implementation on a specific
topic area. The pathways are interactive and designed to be used
online. This pdf version gives you a single pathway diagram and
uses numbering to link the boxes in the diagram to the associated
recommendations.
To view the online version of this pathway visit:
http://pathways.nice.org.uk/pathways/diabetes
Pathway last updated: 24 March 2015. To see details of any updates to this pathway since its launch,
visit: About this Pathway. For information on the NICE guidance used to create this path, see:
Sources.
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Managing blood pressure in type 2 diabetes

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Managing blood pressure in type 2 diabetes

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Person with type 2 diabetes

No additional information

Targets for blood pressure

Set a target blood pressure < 130/80 mmHg for people with kidney, eye or cardiovascular
damage. For others set a target blood pressure < 140/80 mmHg.
Person on antihypertensive therapy at diagnosis of diabetes
Review blood pressure control and medication use.
Make changes only if blood pressure is poorly controlled or current medications are
inappropriate because of microvascular complications or metabolic problems.
Antihypertensive medications can increase the likelihood of side effects such as orthostatic
hypotension in a person with autonomic neuropathy.
If the person's blood pressure reaches and consistently remains at target
If blood pressure reaches and consistently remains at target, monitor every 46 months and
check for possible adverse effects of antihypertensive therapy (including those from
unnecessarily low blood pressure).

Measuring blood pressure

If blood pressure above target, repeat measurements within:

1 month if > 150/90 mmHg
2 months if > 140/80 mmHg
2 months if > 130/80 mmHg and kidney, eye or cerebrovascular damage.

Advising on lifestyle measures

Maintain lifestyle measures and monitor blood pressure 12 monthly until consistently below
target.

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Managing blood pressure in type 2 diabetes

NICE Pathways

For more information on lifestyle measures, see the dietary advice section of this pathway and
the hypertension, physical activity and smoking pathways.

Monitor blood pressure 12 monthly and maintain lifestyle measures

No additional information

If blood pressure above target, start with a calcium channel blocker if

a woman may become pregnant

Antihypertensive medications can increase the likelihood of side effects such as orthostatic
hypotension in a person with autonomic neuropathy.

Offering ACE inhibitors

If blood pressure above target, offer ACE inhibitor (titrate dose).

For people of AfricanCaribbean descent, offer ACE inhibitor plus diuretic or calcium channel
blocker.
If continuing intolerance to ACE inhibitor (other than renal deterioration or hyperkalaemia),
change to an A2RB.
Antihypertensive medications can increase the likelihood of side effects such as orthostatic
hypotension in a person with autonomic neuropathy.

Adding a calcium channel blocker or diuretic

Monitor blood pressure 12 monthly and maintain lifestyle measures but if blood pressure
above target, add a calcium channel blocker or diuretic (usually bendroflumethiazide 2.5 mg
daily).
Antihypertensive medications can increase the likelihood of side effects such as orthostatic
hypotension in a person with autonomic neuropathy.

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Managing blood pressure in type 2 diabetes

NICE Pathways

Adding other drug (either diuretic or calcium channel blocker)

Monitor blood pressure 12 monthly and maintain lifestyle measures but if blood pressure
above target, add other drug (either diuretic or calcium channel blocker).
Antihypertensive medications can increase the likelihood of side effects such as orthostatic
hypotension in a person with autonomic neuropathy.

10 Adding alpha-blocker, beta-blocker or potassium-sparing diuretic

Monitor blood pressure 12 monthly and maintain lifestyle measures but if blood pressure
above target, add alpha-blocker, beta-blocker or potassium-sparing diuretic.
Use a potassium-sparing diuretic with caution if already taking ACE inhibitor or A2RB.
Antihypertensive medications can increase the likelihood of side effects such as orthostatic
hypotension in a person with autonomic neuropathy.

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Managing blood pressure in type 2 diabetes

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Abnormal albumin excretion rate

> 2.5 mg/mmol for men and > 3.5 mg/mmol for women.
Features of the metabolic syndrome
Raised blood pressure, higher waist circumference, low HDL cholesterol, high triglyceride.
Foot protection team
A team with expertise in protecting the foot; typically members of the team include podiatrists,
orthotists and foot care specialists.
Macula
A circle centred on the fovea, with a diameter the distance between the temporal border of the
optic disc and the fovea.
Multidisciplinary foot care team
A team of highly trained specialist podiatrists and orthotists, nurses with training in dressing
diabetic foot wounds and diabetologists with expertise in lower limb complications.

Sources
Type 2 diabetes - newer agents (partial update of CG66) (2009) NICE guideline CG87

Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful
consideration of the evidence available. Those working in the NHS, local authorities, the wider
public, voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties. Implementation of this guidance
is the responsibility of local commissioners and/or providers. Commissioners and providers are
reminded that it is their responsibility to implement the guidance, in their local context, in light of
their duties to avoid unlawful discrimination and to have regard to promoting equality of
opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.

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Managing blood pressure in type 2 diabetes

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Copyright
Copyright National Institute for Health and Care Excellence 2015. All rights reserved. NICE
copyright material can be downloaded for private research and study, and may be reproduced
for educational and not-for-profit purposes. No reproduction by or for commercial organisations,
or for commercial purposes, is allowed without the written permission of NICE.

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nice@nice.org.uk
0845 003 7781

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