Specifities of hypertension management in sub-Saharan type 2 diabetic patient

The association between type 2 diabetes and high blood pressure is highly frequent in sub-Saharan populations, with parallel increase in cardiovascular risk. Apart from the high prevalence, other specificities include a reported lower renin activity and a high sodium and water retention. Diagnosis and monitoring are hampered in resource-limited settings with limited access to adequate health care. In addition, blood pressure control is insufficient despite frequent polypharmacy. Management remains the main challenge with the major objective of reducing the reported high cerebrovascular morbidity and mortality in sub-Saharan Africa. First line dual therapy is strongly suggested by frequently reported failure of the monotherapy, but the optimal antihypertensive class combination has not been directly addressed by existing literature. Resistant hypertension is common, and tends to respond well to add-on low-dose spironolactone.