Background: In patients with diabetes mellitus (DM) there is a clear association between blood pressure
(BP) levels and macrovascular and microvascular complications. However, the BP targets that need to be
achieved for optimal outcomes remain controversial.
Methods: The purpose of this narrative review is to discuss BP targets and management in patients with DM. The
subject of elevated heart rate, which has been associated with mortality in many populations, and which is observed
in some patients with DM will also be addressed.
Results: Most guidelines recommend a target BP in patients with DM of <140/90 mmHg. Most consistently recommended
first-line pharmacotherapy for the treatment of hypertension in non-black patients with DM is an
angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) while for black patients
a calcium channel blocker or a thiazide diuretic. Newer antidiabetic drugs, such as the glucagon-like peptide-1
(GLP-1) receptor agonists and the sodium glucose co-transporter-2 (SGLT2) inhibitors lower not only blood
glucose but also BP levels. The SGLT2 inhibitor-associated decrease in BP is not accompanied by an increase in
heart rate, which is observed however with GLP-1 receptor agonists.
Conclusion: The most widely accepted BP target for patients with DM among guidelines is <140/90 mmHg and
the most widely accepted pharmacotherapy to achieve these goals are ACE inhibitors and ARBs. Newer antidiabetic
medications have been shown to also lower BP and decrease cardiovascular events, thus representing a
promising new therapeutic option for patients with DM and hypertension.