Diabetic patients with hypertension should have their blood pressure (BP) lowered to targeted levels, since serious microvascular and macrovascular diabetic complications are strongly linked to hypertension. The optimal treatment goal for non-pregnant diabetics over age 18 is a systolic BP of <130 and a diastolic <80 mmHg. Patients with a systolic BP >140 or a diastolic BP >90 mmHg should receive drug therapy in addition to recommended lifestyle interventions. Those with a systolic pressure of 130–139 or a diastolic of 80–89 mmHg should be prescribed lifestyle interventions for up to three months. If the inmate fails to achieve a systolic BP <130 or a diastolic BP <80 mmHg within three months, drug therapy should be prescribed. All diabetics with hypertension should ordinarily be treated with an ACE inhibitor. If an ACE inhibitor is contraindicated, consider using an angiotensin receptor blocker (ARB). If targets are not achieved, a thiazide diuretic should be added.
Note: ACE inhibitor therapy should also be considered for diabetic inmates, with or without hypertension, who have other cardiovascular risk factors.