The Association of Physicians of India (API) and the Indian College of Physicians (ICP) jointly introduced new guidelines for managing hypertension in patients with Type 2 Diabetes Mellitus (T2DM) in India. These guidelines address the critical need for a region-specific protocol due to the rising incidence of both conditions in the country.
Hypertension and diabetes are prevalent lifestyle diseases in India, significantly impacting health outcomes and mortality rates. Over half of the individuals with hypertension in India are also affected by T2DM, highlighting the challenges posed by this overlap.
The combined presence of these conditions increases the risk of cardiovascular issues and accelerates kidney disease progression, underscoring the need for effective management strategies. Given that most of these conditions are treated at the primary care level in India, detailed guidelines are essential for managing these patients effectively.
“Global guidelines offer a general framework for treating hypertension in T2DM, but the Indian and Southeast Asian populations have distinct ethnic, clinical, and drug response characteristics compared to Western populations. Recognizing this, the API and ICP have worked with leading experts to develop a protocol tailored for Indian patients. The new guidelines emphasize early detection, comprehensive evaluation, and a multi-faceted treatment approach,” stated
Dr. Jyotirmoy Pal, president elect (2025) of API.
The presence of hypertension in T2DM patients greatly heightens the risk of heart disease, stroke, and peripheral artery disease. It is crucial to assess target organ damage and overall cardiovascular risk to guide treatment decisions. Regular screening for microalbuminuria is advised to detect early kidney dysfunction and potential cardiovascular issues. Specialized risk scores for diabetic patients are preferred over general population scores for a more accurate cardiovascular risk evaluation.
Given the elevated cardiovascular risk, the guidelines advocate for dual antihypertensive therapy, specifically recommending the combination of Angiotensin Receptor Blockers (ARBs) and Calcium Channel Blockers (CCBs) to lower blood pressure and reduce cardiovascular risks.
A significant update in the 2024 guidelines is the inclusion of newer CCBs, with a particular emphasis on Cilnidipine. Since its introduction in India in 2007, Cilnidipine has demonstrated benefits beyond blood pressure reduction, including organ protection, particularly for the kidneys. The guidelines suggest using Cilnidipine alongside ARBs to maximize these advantages, while also considering individual patient factors and comorbidities.
The guidelines also highlight the importance of Renin-Angiotensin System (RAS) blockers in the treatment regimen due to their proven effectiveness in clinical trials for preventing and managing diabetic kidney complications. Additionally, newer anti-diabetic agents such as SGLT2 inhibitors and GLP-1 receptor agonists are recommended for improving glycemic control and offering vascular protection.
The API-ICP guidelines also outline situations where referral to specialists is necessary for better disease management.
A notable feature of the new guidelines is the recommendation to use multiple methods for detecting and measuring hypertension, including home blood pressure monitoring. This approach empowers patients to take an active role in managing their condition, enhancing adherence to treatment and improving long-term outcomes.
Furthermore, the guidelines promote the integration of lifestyle changes to improve treatment efficacy. For the first time, yoga is recommended as an adjunct therapy for hypertension management in T2DM, with an emphasis on its holistic health benefits.
As reported by pharmabiz.com, healthcare professionals across India and beyond are encouraged to adopt these guidelines to improve patient care and manage hypertension in diabetic patients effectively. The guidelines are available in the Journal of Association of Physicians of India (JAPI) as a valuable resource for clinicians aiming to deliver optimal care.