Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For adults starting antihypertensive treatment who have type 2 diabetes, the first-line treatment should be an ACE inhibitor or an ARB NICE NG136. If an ACE inhibitor is not tolerated, an ARB should be offered NICE NG136. It is important not to combine an ACE inhibitor with an ARB NICE NG136.
For adults with hypertension and chronic kidney disease, the choice of antihypertensive drug treatment should be guided by NICE's guideline on chronic kidney disease NICE NG136.
Blood pressure targets:
For specialist consideration:
For adults with hypertension and chronic kidney disease, the choice of antihypertensive drug treatment should be guided by NICE's guideline on chronic kidney disease NICE NG136.
Blood pressure targets:
- For adults under 80 with hypertension and type 2 diabetes, or chronic kidney disease with an albumin to creatinine ratio of 70 mg/mmol or more, the clinic blood pressure target is below 130/80 mmHg NICE NG136.
- For adults aged 80 and over with hypertension and type 2 diabetes, the clinic blood pressure target is below 150/90 mmHg NICE NG136.
- For adults aged 80 and over with chronic kidney disease and an albumin to creatinine ratio of 70 mg/mmol or more, the clinic blood pressure target is below 130/80 mmHg NICE NG136.
For specialist consideration:
- When choosing antihypertensive drug treatment for adults of Black African or African–Caribbean family origin with hypertension and type 2 diabetes, consider an ARB in preference to an ACE inhibitor NICE NG136.
- If there is evidence of heart failure, offer a thiazide-like diuretic and follow NICE's guideline on chronic heart failure NICE NG136.
- If starting or changing diuretic treatment, offer a thiazide-like diuretic, such as indapamide, in preference to a conventional thiazide diuretic NICE NG136.