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Diabetes mellitus (DM) and essential hypertension are common conditions that are frequently present together. Both are considered risk factors for cardiovascular disease and microvascular complications and therefore treatment of both conditions is essential. Many papers were published on blood pressure (BP) targets in diabetic patients, including several works published in the last 2 years. As a result, guidelines differ in their recommendations on BP targets in diabetic patients. The method by which to control hypertension, whether pharmacological or non-pharmacological, is also a matter of debate and has been extensively studied in the literature.
In recent years, new medications were introduced for the treatment of DM, some of which also affect BP and the clinician treating hypertensive and diabetic patients should be familiar with these medications and their effect on BP. In this manuscript, we discuss the evidence supporting different BP targets in diabetics and review the various guidelines on this topic. In addition, we discuss the various options available for the treatment of hypertension in diabetics and the recommendations for a specific treatment over the other. Finally we briefly discuss the new diabetic drug classes and their influence on BP.
Essential hypertension and diabetes mellitus (DM) are both extremely common conditions and therefore it is not surprising that their co-existence is extremely prevalent. Since both are considered risk factors for coronary artery disease, cerebrovascular disease, renal failure and congestive heart failure, treatment of both conditions is essential. Whether blood pressure (BP) should be lowered to a different target in diabetic patients has been a debate for many years. Current guidelines are inconsistent regarding BP target in diabetic patients. Whereas several guidelines recommend a BP goal of <140/90 mmHg [1, 2], some recommend a lower target for diastolic BP [3, 4] and some recommend lower systolic BP thresholds in certain diabetic population [5–7].
The class of drug treatment most appropriate for the treatment of hypertensive diabetics is also unclear and different guidelines emphasize use of different drug classes for the treatment of hypertension in diabetic patients. Recently introduced drug classes for the treatment of DM have also been found to lower BP, thus making the interaction between BP and DM even more complex. In this review, we discuss the epidemiology of diabetes and hypertension, the benefit of lowering BP in diabetic patients, the target BP and the recommended treatment to achieve the target in these patients. This review deals mainly with BP control in type 2 DM, but some of the data derived from studies that included also non diabetic patients.
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