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1. How do you reduce cardiovascular risk?
The principal cause of early death in type 2 diabetes is from cardiovascular disease (myocardial infarction and stroke) and multiple risk factors should be addressed.1
NICE recommends a target blood pressure for people with type 2 diabetes of 140/80 (similar to other guidelines) lowered to 130/80 for adults with renal or eye damage or previous cerebrovascular disease (stroke or transient ischaemic attack).2 The stepwise introduction of antihypertensive medications is summarised in table 1.3
For Afro-Caribbeans, then a combination of angiotenisn converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) plus either calcium channel blocker (CCB) or thiazide-like diuretic is recommended as first-line therapy. In the case of a woman where pregnancy is anticipated then angiotensin based antihypertensives and diuretics should be avoided; options here include a CCB, methyldopa or labetolol.
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