RSSDI releases guidelines for management of Hypertension in Diabetes Mellitus 2022

Catering to the pressing need to outline an evidence and experience-based comprehensive treatment yardstick, the first-ever Indian guideline for the management of hypertension in Diabetes Mellitus has been released by the RSSDI on the 15th of Dec 2022.

The guideline has been published in the latest issue of the International Journal of Diabetes in Developing Countries – the IJDDC.

The guideline recommends that :-

• Calcium channel blockers (CCBs) must be preferred over beta-blockers and thiazides in combination therapy with Angiotensin II Receptor blockers (ARBs) for better cardiovascular and renoprotection in diabetic hypertensive Indian patients.
• Cilnidipine to be a comparatively more effective and safer novel molecule as compared to conventional CCBs for Indian diabetic hypertensive patients (Grade A recommendation).
• ARBs must be preferred over ACEi in diabetic patients with hypertension, telmisartan or azilsartan being selected as the first-line agent (grade B recommendation).
• ARBs, either alone or in combination with CCBs, can be used for blood pressure (BP) control in diabetic patients.
• Among the CCBs, novel molecules (e.g.cilnidipine) are recommended in combination with ARBs for better cardiovascular and reno-protection in diabetic hypertensive patients.
• Cilnidipine is a comparatively more efective and safer novel molecule as compared to conventional CCBs for Indian diabetic hypertensive patients (grade A recommendation).

Amlodipine and cilnidipine are equally efficacious in reducing blood pressure; however, the incidence of pedal edema is reportedly lower with cilnidipine than with Amlodipine.

When administered at a dosage of 5–20 mg/day, based on the patient's clinical profile, cilnidipine facilitates BP reduction, helps reduce heart rate and serum triglyceride levels in Indian patients, suggestive of cardioprotective benefits.

Talking about the use of ARBs, the guidelines note that Telmisartan stands out due to its beneficial effects on fasting blood glucose and insulin levels.

The guideline also stressed the importance of evaluating individual profile of the patient and their response to the treatment for selecting appropriate treatment agents for hypertension management (grade A). In patients at risk of CVDs, renal disorders, or cerebrovascular disorders, combination therapy must be preferred for reducing risk of mortality. (grade B)

To read the full guidelines, click on the following link- RSSDI Guidelines for the management of hypertension in patients with diabetes mellitus | SpringerLink