Oscillating blood pressure therapeutic target in type 2 diabetes patients with hypertension

There is controversy regarding the J-shaped curve associating low blood pressure (BP) with increased cardiovascular events and mortality in hypertensive treated patients. This has partially motivated the revision of several hypertension treatment guidelines to raise the threshold for the definition and initiation of pharmacological treatment of hypertension in diabetes patients from 130/80 to 140/90 mmHg. However, there are increasing evidence that the increase cardiovascular risk caused by lower BP is not due to hypertensive treatment itself, rather to co-morbidities, especially in patients with diabetes. Much more, lower BP than currently recommended might be associated with significantly lower risk of cardiovascular events in diabetes patients. In this paper, we revisit the issue of ideal therapeutic BP target in diabetes patients with hypertension.