V. Goals of Therapy for Adults With Hypertension Without Compelling Indications for Specific Agents

Prevention and Treatment

Recommendations

  1. The SBP treatment goal is a pressure level of < 140 mm Hg (Grade C). The DBP treatment goal is a pressure level of < 90 mm Hg (Grade A). These targets were established using OBPM.

Key Messages

  • Hypertension frequently coexists with other conditions that influence therapeutic decision-making. Polypharmacy and competing risks need to be considered carefully.
  • Adults with diabetes and certain forms of chronic kidney disease (Table 9) might benefit from more intensive BP targets (ie, SPB 130 mm Hg or 120 mm Hg).

Diabetes and Hypertension

There has been significant interest in the potential role of newer diabetes therapies in the management of cardiovascular risk in adults with diabetes and hypertension. This topic has been reviewed and discussed by the HCGC at our 2017 and 2019 consensus conferences and a formal recommendation has not been developed for the use of sodium-glucose co transporter-2 (SGLT2) inhibitors in the management of persons with comorbid diabetes and hypertension. However, the rationale for reviewing this topic is summarized herein. SGLT2s have been shown to improve survival and improve clinical outcomes in persons with type 2 diabetes, diabetes and heart failure, and diabetes-related kidney disease (GFR 30-60 mL/min/m2). Benefits on heart outcomes (namely reduced hospitalizations for heart failure) have been recently reported in the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) trial, which enrolled 4744 patients with HFrEF, 58% of which did NOT have type 2 diabetes. Although SGLT2s appear to have clinically significant benefits in persons with diabetes, diabetes-related kidney disease, and HFrEF, SGLT2s are not an approved antihypertensive therapy, and have not been included in the Hypertension Canada guidelines as a recommended therapy for patients with these conditions. However, Hypertension Canada does acknowledge that there is a potential role for SGLT2s in patients to reduce weight, improve hemoglobin A1C, modestly reduce , and improve cardiovascular outcomes in patients with complex comorbidities.