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Diabetes And Hypertension A Position Statement By The Ada

Aace Algorithm Offers New Guidance On Managing T2dm

Aace Algorithm Offers New Guidance On Managing T2dm

AACE Algorithm Offers New Guidance on Managing T2DM How Does It Compare With ADA/EASD Guidelines? This feature requires the newest version of Flash. You can download it here . Position Statements vs Algorithms for Type 2 Diabetes Hi. I am Dr. Anne Peters from the University of Southern California. Today I will take on the difficult task of comparing the American Association of Clinical Endocrinologists (AACE) algorithms for the treatment of type 2 diabetes[ 1 ] with the position statement of the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) for the management of hyperglycemia in type 2 diabetes.[ 2 ] In fairness, I will disclose that I was one of the authors of the ADA/EASD position statement. I have biases, but I also know the process by which algorithms are created. Thus, I have some insider information to use when evaluating these statements. Furthermore, it is difficult to compare them while using the terms "algorithm," "position statement," and "guidelines" correctly. The ADA/EASD document is a position statement, which means that it is not meant to be an algorithm or a guideline. The AACE document is a series of algorithms with very minimal text; it delineates the treatment of all elements of type 2 diabetes, (hyperglycemia, obesity, prediabetes, hypertension, and dyslipidemia). The ADA/EASD position statement looks only at the treatment of hyperglycemia in type 2 diabetes. I will focus first on that position statement and then I will discuss the AACE algorithms. Continue reading >>

Ada Issues New Position Statement To Manage Diabetes And Hypertension

Ada Issues New Position Statement To Manage Diabetes And Hypertension

With George L. Bakris, MD, Priyathama Vellanki, MD, and Mark E. Molitch, MD For the first time in nearly 15 years, the American Diabetes Association (ADA) has updated its position statement on the screening and diagnosis of hypertension in patients with diabetes.1 The update to the existing guideline is of vital importance given that patients with diabetes often develop hypertension, and it is a strong risk factor for cardiovascular disease, heart failure, and microvascular complications. The position statement is authored by nine leading diabetes experts on behalf of the ADA, including George L. Bakris, MD, professor of medicine and director of the ASH Comprehensive Hypertension Center at the University of Chicago Medicine. Dr. Bakris spoke with EndocrineWeb to offer his insight on key changes to the guidelines of particular interest to clinicians. The position statement was made available August 22 online and is scheduled to be published in the September 2017 issue of Diabetes Care. 1 "In terms of blood pressure goals, we did it in two tiers," Dr. Bakris told EndocrineWeb. "We said everyone should be below 140 over 90, regardless.'' Blood pressure should also be measured at every routine clinical care visit. Furthermore, Dr. Bakris said there is an indication for reducing blood pressure below 130/80. "Most people should be urged to go to 130/80 [or below] because the cardiovascular risk in that subgroup of people is higher than the general population," he stated. "The level of evidence is not as strong, but it's reasonable." He cited the findings from the Action to Control Cardiovascular Risk In Diabetes (ACCORD) blood pressure trial (ACCORD BP), among others, supporting the lower target. In the ACCORD BP trial, intensive blood pressure control (below 120 mmHg), comp Continue reading >>

Us Hypertension In Diabetes Position Statement Released

Us Hypertension In Diabetes Position Statement Released

US hypertension in diabetes position statement released A position statement based on hypertension and diabetes has been released in the US. The document , which was last updated in 2003, was written by nine leading diabetes experts on behalf of the American Diabetes Association (ADA). The update incorporates findings from recent, noteworthy BP trials, including ACCORD, ADVANCE, SPRINTT and the Hypertension Optimal Treatment (HOT) trial. A newly added pictorial algorithm for the treatment of confirmed hypertension in people with diabetes has also been included. Speaking to Endocrine Today,George Bakris,professor of medicine and director of the American Society of Hypertension (ASH) and the Comprehensive Hypertension Center at University of Chicago Medicine and a co-author of the statement, said: There are a number of new findings in this position paper.There is a recommendation to check standing BP on initial visits among people with diabetes to assess both autonomic function as well as potential volume depletion. While there is a strong position for a BP of less than 140/90 mm Hg, there is a clear recommendation for a BP of less than 130/80 mm Hg once the patient understands they are at high CV risk. Subsequent analyses from a long-term follow-up of ACCORD (ACCORDIAN) and multiple meta-analyses in thousands of patients suggest that a BP of less than 140 mm Hg clearly shows a significant reduction in CVD events and a slowed progression of nephropathy. Professor Bakris aded: Those who achieve a BP of less than 130 mm Hg show a further, albeit smaller, reduction in CVD events, but not renal events. Lifestyle management plans for lowering BP have also been highlighted in the guideline and include suggestions on weight loss, nutrition and increased physical activity. The s Continue reading >>

Position Statement By The American Diabetes Association: Diabetes And Hypertension

Position Statement By The American Diabetes Association: Diabetes And Hypertension

Home / Specialties / Cardiology / Position Statement by the American Diabetes Association: Diabetes and Hypertension Position Statement by the American Diabetes Association: Diabetes and Hypertension Updated blood pressure control numbers may have cardiovascular benefits for some patients. From 2000 to 2012, the American Diabetes Association reported that approximately 71% of patients with diabetes had a blood pressure 140/90 mmHg or were taking medications to help manage their blood pressure. Diabetes and hypertension are interrelated diseases that significantly increase a persons risk for atherosclerotic cardiovascular disease. Hypertension increases a persons risk of heart attack, stroke, kidney disease and other health problems. Patients with diabetes are already at an increased risk for these complications and considering hypertension is twice as prevalent in patients with diabetes as in those without, it is imperative that a patients blood pressure is well-controlled. The American Diabetes Association recently published a Position Statement intended to update the assessment and treatment of hypertension among individuals with diabetes. This is the first statement released on this topic since 2003 and includes recommendations based on evidence from the SPRINT and ACCORD trials. While some recommendations have changed, many have remained the same. Blood pressure should continue to be measured at every office visit with any reading 140/90 mmHg confirmed by multiple readings on separate visits. All patients with diagnosed hypertension should have a home blood pressure monitor and should be encouraged to record their readings daily. Most patients with type 2 diabetes should be treated to obtain a blood pressure 140/90 mmHg. Although, patients at higher risk of cardiov Continue reading >>

Ada Issues Updated Position Statement On Hypertension And Diabetes

Ada Issues Updated Position Statement On Hypertension And Diabetes

ACP Diabetes Monthly | From ACP Internist Weekly | September 8, 2017 ADA issues updated position statement on hypertension and diabetes The statement updates the American Diabetes Association's 2003 position statement on this topic and summarizes clinical trials of intensive hypertension treatment strategies. The American Diabetes Association (ADA) recently issued an updated position statement on diagnosis and treatment of hypertension in patients with diabetes. The position statement, which updates the ADA's 2003 position statement on this topic, will appear in the September Diabetes Care and was published online on Aug. 22. It was developed by nine diabetes experts and summarizes clinical trials of intensive hypertension treatment strategies , such as the ACCORD BP (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure) trial, the ADVANCEBP (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled EvaluationBlood Pressure) trial, the HOT (Hypertension Optimal Treatment) trial, and SPRINT (Systolic Blood Pressure Intervention Trial). The resulting recommendations include the following: Blood pressure should be measured at every routine clinical care visit in people with diabetes. If blood pressure is found to be 140/90 mm Hg or higher, it should be confirmed with multiple readings, including on a different day (B recommendation). All hypertensive patients with diabetes should have home blood pressure monitored to identify white-coat hypertension (B recommendation). The treatment goal for most patients with diabetes and hypertension should be below 140 mm Hg systolic and below 90 mm Hg diastolic (A recommendation). For patients at high risk for cardiovascular disease, lower targets, such as below 130/80 mm Hg, may be appropriate if they Continue reading >>

Diabetes And Hypertension: A Position Statement By The American Diabetes Association

Diabetes And Hypertension: A Position Statement By The American Diabetes Association

Hypertension is common among patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex, race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other factors (1–3). Furthermore, hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. ASCVD—defined as acute coronary syndrome, myocardial infarction (MI), angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin—is the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes. Numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications in people with diabetes (4–8). Large benefits are seen when multiple risk factors are addressed simultaneously (9). There is evidence that ASCVD morbidity and mortality have decreased for people with diabetes since 1990 (10,11) likely due in large part to improvements in blood pressure control (12–14). This Position Statement is intended to update the assessment and treatment of hypertension among people with diabetes, including advances in care since the American Diabetes Association (ADA) last published a Position Statement on this topic in 2003 (3). DEFINITIONS, SCREENING, AND DIAGNOSIS Blood pressure should be measured at every routine clinical care visit. Patients found to have an elevated blood pressure (≥140/90 mmHg) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension. B All hypertensive pa Continue reading >>

Ada Updates Position Statement On Hypertension In Diabetes

Ada Updates Position Statement On Hypertension In Diabetes

ADA updates position statement on hypertension in diabetes For most patients with diabetes and hypertension, a combination of in-clinic and home-based blood pressure monitoring, a BP target of less than 140/90 mm Hg, individualized antihypertensive treatment and lifestyle modification are key to reduce the risk for atherosclerotic cardiovascular disease, heart failure and microvascular complications, according to a new position statement released by the American Diabetes Association. The statement, written by nine leading diabetes experts on behalf of the ADA, updates the latest advances in care since the association last published a statement on the topic in 2003. The update incorporates findings from recent, noteworthy BP trials, including ACCORD, ADVANCE, SPRINT and the Hypertension Optimal Treatment (HOT) trial, and includes a newly added pictorial algorithm for the treatment of confirmed hypertension in patients with diabetes. There are a number of new findings in this position paper, George Bakris, MD, professor of medicine and director of the ASH Comprehensive Hypertension Center at University of Chicago Medicine and a co-author of the statement, told Endocrine Today. There is a recommendation to check standing BP on initial visits among people with diabetes to assess both autonomic function as well as potential volume depletion. While there is a strong position for a BP of less than 140/90 mm Hg, there is a clear recommendation for a BP of less than 130/80 mm Hg once the patient understands they are at high CV risk. Subsequent analyses from a long-term follow-up of ACCORD (ACCORDIAN) and multiple meta-analyses in thousands of patients suggest that a BP of less than 140 mm Hg clearly shows a significant reduction in CVD events and a slowed progression of nephrop Continue reading >>

Lead Author, Dr. Ian De Boer - Diabetes And Hypertension: A Position Statement By The American Diabetes Association

Lead Author, Dr. Ian De Boer - Diabetes And Hypertension: A Position Statement By The American Diabetes Association

Lead author, Dr. Ian de Boer - Diabetes and Hypertension: A Position Statement by the American Diabetes Association Lead author, Dr. Ian de Boer - Diabetes and Hypertension: A Position Statement by the American Diabetes Association Ian H. de Boer , Sripal Bangalore, Athanase Benetos, Andrew M. Davis, Erin D. Michos, Paul Muntner, Peter Rossing, Sophia Zoungas and George Bakris Hypertension is common among patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex, race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other factors. Furthermore, hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. ASCVDdefined as acute coronary syndrome, myocardial infarction (MI), angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic originis the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes. Please read the complete paper by clicking on the title above Continue reading >>

Ada Issues Updated Position Statement On Hypertension And Diabetes

Ada Issues Updated Position Statement On Hypertension And Diabetes

ACP Internist Weekly | Hypertension | August 29, 2017 ADA issues updated position statement on hypertension and diabetes The statement updates the ADA's 2003 position statement on this topic and summarizes clinical trials of intensive hypertension treatment strategies. The American Diabetes Association (ADA) issued an updated position statement last week on diagnosis and treatment of hypertension in patients with diabetes. The position statement, which updates the ADA's 2003 position statement on this topic, will appear in the September Diabetes Care and was published online on Aug. 22. It was developed by nine diabetes experts and summarizes clinical trials of intensive hypertension treatment strategies , such as the ACCORD BP (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure) trial, the ADVANCEBP (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled EvaluationBlood Pressure) trial, the HOT (Hypertension Optimal Treatment) trial, and SPRINT (Systolic Blood Pressure Intervention Trial). The resulting recommendations include the following: Blood pressure should be measured at every routine clinical care visit in people with diabetes. If blood pressure is found to be 140/90 mm Hg or higher, it should be confirmed with multiple readings, including on a different day. The treatment goal for most patients with diabetes and hypertension should be below 140 mm Hg systolic and below 90 mm Hg diastolic. For patients at high risk for cardiovascular disease, lower targets, such as below 130/80 mm Hg, may be appropriate if they are achievable without undue treatment burden. For patients whose systolic blood pressure is above 120 mm Hg or diastolic blood pressure is above 80 mm Hg, lifestyle intervention should involve weight loss in those w Continue reading >>

Ada Offers Position Statement On Diabetes And Hypertension

Ada Offers Position Statement On Diabetes And Hypertension

The American Diabetes Association (ADA) today offered a position statement on treating diabetes and hypertension for the first time since 2003. The American Diabetes Association (ADA) today offered a position statement on treating diabetes and hypertension for the first time since 2003. The statement incorporates findings from several key studies since that time, notably the 2010 ACCORD study (Action to Control Cardiovascular Risk in Diabetes). The statement, published in the journal Diabetes Care, features recommendations for diagnosing hypertension in patients with diabetes and an algorithm treating them, depending on how elevated their blood pressure is. The authors note that hypertension is a strong risk factor in atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications that are the hallmarks of advanced diabetes, which contribute to both direct and indirect costs. In 2013, the ADA found that the annual costs of diabetes in the United States totaled $245 billion. Those with a blood pressure between 140/90 mm Hg and 160/100 mm Hg should start on a single antihypertensive agent, and those with a reading higher than 160/100 mg Hg should immediately start with 2 agents; both groups should improve their lifestyle management. The algorithm goes on to recommend specific agents depending on whether patients meet targets or experience adverse effects. The guideline continues the advice that most patients with diabetes should be treated to a blood pressure goal of <140/90 mm Hg; a goal of <130/80 can be considered for patients who have other cardiovascular risk factors. This follows results of ACCORD BP, which found no difference in a composite of cardiovascular events for patients whose blood pressure was treated to a much lower target o Continue reading >>

Review Of The Ada Standards Of Medical Care In Diabetes 2018 | Annals Of Internal Medicine | American College Of Physicians

Review Of The Ada Standards Of Medical Care In Diabetes 2018 | Annals Of Internal Medicine | American College Of Physicians

Author, Article, and Disclosure Information This article was published at Annals.org on 3 April 2018. St. Mark's Hospital and St. Mark's Diabetes Center, Salt Lake City, Utah (J.J.C.) UND School of Medicine and Health Sciences, Grand Forks, North Dakota (E.L.J.) Touro University College of Osteopathic Medicine, Vallejo, California (J.H.S.) Utah State University, Taylorsville, Utah (L.P.) Acknowledgment: The authors thank Sarah Bradley; Matt Petersen; and Erika Gebel Berg, PhD, for their invaluable assistance in the reviewing and editing of this manuscript. The full Standards of Medical Care in Diabetes2018 was developed by the ADA's Professional Practice Committee: Rita R. Kalyani, MD, MHS (Chair); Christopher Cannon, MD; Andrea L. Cherrington, MD, MPH; Donald R. Coustan, MD; Ian de Boer, MD, MS; Hope Feldman, CRNP, FNP-BC; Judith Fradkin, MD; David Maahs, MD, PhD; Melinda Maryniuk, Med, RD, CDE; Medha N. Munshi, MD; Joshua J. Neumiller, PharmD, CDE; and Guillermo E. Umpierrez. ADA staff support includes Erika Gebel Berg, PhD; Tamara Darsow, PhD; Matt Petersen; Sacha Uelmen, RDN, CDE; and William T. Cefalu, MD. Disclosures: Dr. Chamberlain reports other support from Novo Nordisk, Sanofi Aventis, Janssen, and Merck outside the submitted work. Dr. Johnson reports personal fees from Novo Nordisk, Medtronic, and Sanofi outside the submitted work. Dr. Rhinehart reports employment with and stock ownership in Glytec. Dr. Shubrook reports personal fees from Novo Nordisk, Lilly Diabetes, and Intarcia outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0222 . Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that he Continue reading >>

Managing Hypertension In Diabetes: A Position Statement From The Ada

Managing Hypertension In Diabetes: A Position Statement From The Ada

Managing hypertension in diabetes: a position statement from the ADA Managing hypertension in diabetes: a position statement from the ADA The ADA has released a position statement to update the assessment and treatment of hypertension among patients with diabetes. The American Diabetes Association (ADA) has released a position statement to update the assessment and treatment of hypertension among patients with diabetes. The position statement, published in Diabetes Care, includes advances in care since the ADA last published a statement on this topic in 2003. The ADA notes that antihypertensive therapy is shown to reduce atherosclerotic cardiovascular disease (ASCVD) events, heart failure, and microvascular complications in patients with diabetes. There have also been reductions in ASCVD morbidity and mortality in patients with diabetes since 1990, which are likely due to improvements in blood pressure control. Treatment should be individualized to the specific patient based on their comorbidities; their anticipated benefit for reduction in ASCVD, heart failure, progressive diabetic kidney disease, and retinopathy events; and their risk of adverse events, according to the ADA. This conversation should be part of a shared decision-making process between the clinician and the individual patient. The ADA has made the following recommendations: Clinicians should measure blood pressure at every routine clinical care visit. Patients with elevated blood pressure 140/90 mmHg should have blood pressure confirmed with multiple readings to diagnose hypertension (Grade B recommendation). Hypertensive patients with diabetes should have home blood pressure monitoring to identify white-coat hypertension (Grade B recommendation). Orthostatic measurement of blood pressure should be per Continue reading >>

2017 Ada Position Statement: Hypertension In Diabetes

2017 Ada Position Statement: Hypertension In Diabetes

Blood pressure should be measured at every routine clinical care visit. Patients found to have an elevated blood pressure (140/90 mmHg) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension. ALL hypertensive patients with diabetes should have home blood pressure monitored to identify white-coat hypertension. Orthostatic measurement of blood pressure should be performed during initial evaluation of hypertension and periodically at follow-up, or when symptoms of orthostatic hypotension are present, and regularly if orthostatic hypotension has been diagnosed. Most patients with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg and a diastolic blood pressure goal of <90 mmHg. Lower systolic and diastolic blood pressure targets, such as <130/80 mmHg, may be appropriate for individuals at high risk of cardiovascular disease if they can be achieved without undue treatment burden. Patients with confirmed office-based blood pressure 140/90 mmHg should, in addition to lifestyle therapy, have timely titration of pharmacologic therapy to achieve blood pressure goals. Patients with confirmed office-based blood pressure 160/100 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes. Treatment for hypertension should include drug classes demonstrated to reduce cardiovascular events in patients with diabetes: ACE inhibitors, angiotensin receptor blockers (ARBs), thiazide-like diuretics, or dihydropyridine CCBs. Multiple-drug therapy is generally required to achieve blood pressure targets (but not a combination of AC Continue reading >>

Ada Officials Make Therapeutic Recommendations For Diabetes Patients With Hypertension

Ada Officials Make Therapeutic Recommendations For Diabetes Patients With Hypertension

ADA Officials Make Therapeutic Recommendations for Diabetes Patients With Hypertension Patients with diabetes who have hypertension should, at a minimum, be treated to blood pressure targets of less than 140/90 mmHg, and even lower targets for some patients at higher risk of cardiovascular disease, according to a position paper released recently by the American Diabetes Association (ADA).1 The ADA's recommendations, which include a newly added pictorial algorithm for the treatment of confirmed hypertension in people with diabetes, are featured in the the September issue of Diabetes Care. The Association recommends that people with diabetes have blood pressure measurements taken at every routine clinical visit and, for people with diagnosed hypertension, taken at home as well. Patients with an elevated blood pressure should have their blood pressure conrmed with multiple readings, including measurements on a separate day, to diagnose hypertension, according to the panel. Lifestyle management plans for lowering blood pressure are also highlighted in the guidelines and include suggestions on weight loss, nutrition, and increased physical activity. The statement also details, step-by-step, the recommended approach for the use of medication in the treatment of hypertension in people with diabetes, which depends on initial blood pressure, kidney health, response to treatment and adverse effects. "patients with aconfirmed blood pressure 160/100 mmHg should have prompt initiation and timely titration of 2 drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes, in addition to lifestyle therapy (Grade A recommendation). Treatment include drug classes demonstrated to reduce cardiovascular events in patients with diabetes Continue reading >>

2017 Position Statement From The American Diabetes Association (ada) On Hypertension In Diabetes

2017 Position Statement From The American Diabetes Association (ada) On Hypertension In Diabetes

2017 Position Statement from the American Diabetes Association (ADA) on Hypertension in Diabetes Patients with diabetes often have numerous comorbid conditions such as obesity, heart disease, kidney disease and hypertension to name a few. Hypertension or high blood pressure (BP), in particular, can lead to increased risks for atherosclerotic cardiovascular disease (ASCVD), heart failure (HF) and attendant microvascular complications. The last time the ADA provided a position statement on hypertension was more than 15 years ago. Given the increasing rise in the numbers of people afflicted by diabetes, increased BMI and obesity, it is timely that this body has revised its statement on hypertension in this patient population. Predominantly focusing on Type 2 Diabetes (T2D), the position statement can be summarized as follows: Regular monitoring of BP in the office and in the home Careful assessment and implementation of all antihypertensive medications and supplements particularly in patients with known kidney disease or clinical proteinuria (300 mg albumin/g creatinine) A BP goal for all diabetics of <140/90 mm Hg based on clinical evidence With individualization of targets if <130/80 mm Hg based on severity of CV risk and The position statement also describes in detail how BP should be taken at every clinic visit, with repeated measurements to confirm the diagnosis of hypertension, the use of home BP measurement to confirm the elevations that may be seen during the clinic visit, and the importance of checking for orthostatic hypotension at the initial hypertension visit and periodically thereafter. This highlights the importance of autonomic instability in diabetes. Overall, this document is an important read for the practitioner who cares for patients with diabetes and Continue reading >>

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