Management Strategies for Hypertension in Patients with Diabetes and Other Co-morbidities: Insights from the HYDIA Cross-sectional Survey

Introduction: The simultaneous rise of hypertension and diabetes in Indian patients necessitates effective management strategies to prevent severe complications. The study addresses the limited understanding of hypertension management in diabetic patients within the Indian clinical context, highlighting gaps in regionspecific data on expert perceptions and preferred strategies. Aim: To assess Indian physicians’ perceptions and practices regarding the impact of hypertension in patients with diabetes and the most appropriate strategies for managing it. Materials and Methods: The present study was a cross-sectional, questionnaire based electronic survey. A total of 1618 physicians throughout India were invited to participate in an online survey and virtual meetings. The study questionnaire had two sections. Section 1 consisted of four questions focusing on the detrimental effects of hypertension on diabetes. Section 2 included seven questions regarding appropriate management approaches for hypertension. The data collected was analysed using Microsoft Excel 2019 and presented as frequency. Results: Majority of the physicians (39.9%) were from Western region. The majority of participants in this survey had 10-20 years of experience (n=504, 41.2%) and practiced in their clinic (n=541, 44.3%). The expert panel reported that cardiac events (48.22%) were the most common consequence of hypertension in diabetic patients. They recommended telmisartan (85.9%), amlodipine (64.7%), and metoprolol (76.0%) as preferred treatments for managing diabetes with hypertension and cardiovascular Co-morbidities. For patients with diabetes, hypertension, and Chronic Kidney Disease (CKD), telmisartan (84.0%), amlodipine (63.4%), and hydrochlorothiazide (63.1%) were favoured. Additionally, 51.3% of diabetologists did not recommend the use of dual RAAS inhibitors (ACE inhibitors+ARB). In a patient with diabetes, hypertension and a history of stroke, if Blood Pressure (BP) remains uncontrolled on an optimal ARB dose, Calcium Channel Blockers (CCBs) should be added as a second-line therapy. Conclusion: Appropriate management strategies, such as enhancing medication adherence, patient education, and selecting effective treatments, can prevent the detrimental effects of hypertension in patients with diabetes and Co-morbidities. Indian diabetologists typically prefer ARBs as the first-line therapy and CCBs, beta-blockers, or diuretics as second-line options. The most commonly chosen medications include telmisartan, amlodipine, metoprolol, and hydrochlorothiazide. As a secondline treatment, CCBs are particularly preferred for patients who have both diabetes and CKD.