When should the treatment of hypertension in diabetic patients begin and in what way How long will the treatment last

Since hypertension in the diabetic individual is defined as the presence of BP levels > 130/80 mmHg, it is obvious that the therapeutic approach should begin when its values exceed these limits. Initially, for blood pressure levels of 130-139/80-89 mmHg, it is advisable for the first approach to be non-pharmaceutical, and to try to reduce the BP with lifestyle modification measures. These include an effort of body weight reduction in obese patients (with diet and exercise), reduction of salt and alcohol consumption, and smoking cessation. Weight loss is the most efficient of these measures, as regards the success of BP reduction (a loss of 10kg body weight usually produces a BP fall by 5-20mmHg). A reduction of dietary caloric consumption is very important, with fat restriction, mainly saturated animal fat, being the basic factor. Salt should be limited to less than 6g per day. Alcoholic beverages should also not exceed 2-3 glasses of wine (or equivalent alcohol quantity in other drinks) for men and 1-2 glasses of wine (or equivalent) for women. Regular physical activity (30-45 min brisk walking per day, for 5-7 days a week, is recommended) will also contribute to the stabilization of weight loss and also has beneficial effects on BP independent from the weight loss. Smoking contributes to vasoconstriction and to an increase of atherogenesis risk, and thus its cessation has multiple beneficial effects.

The effects of the application of these lifestyle modification measures should be monitored by the treating physician. If after three months the BP has not fallen to the target levels (< 130/80 mmHg) or if from the beginning BP was > 140/90 mmHg, it is recommended that antihypertensive pharmaceutical treatment be started. The continuation of treatment (always in combination with lifestyle modification measures) should probably be continued for life, since hypertension is a chronic disease that is almost never cured (unless secondary curable causes are found in the initial physical and laboratory examinations).

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