Interplay Between Functional Capacity and Blood Pressure Regulation in Type 2 Diabetes Mellitus: A Systematic Review of Current Evidence and Clinical Implications

Background: Type 2 Diabetes Mellitus (T2DM) is strongly associated with cardiovascular dysfunction, impaired functional capacity, and hypertension, all of which contribute to increased morbidity and mortality. This systematic review evaluated the relationship between functional capacity and blood pressure regulation in individuals with T2DM. Methods: A systematic literature search was conducted according to PRISMA guidelines across PubMed, Scopus, and Google Scholar for studies published between January 2000 and June 2025. Eligible studies included adults with T2DM assessing functional capacity measures such as six-minute walk test (6MWT), VO₂max, or cardiopulmonary exercise testing alongside blood pressure. Study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Due to heterogeneity, findings were synthesized narratively. Results: Eleven studies were included comprising randomized controlled trials, cohort, observational, and cross-sectional studies. Evidence consistently demonstrated reduced functional capacity and a high prevalence of hypertension among individuals with T2DM. Lower VO₂max, impaired exercise tolerance, and reduced 6MWT performance were associated with arterial stiffness, poor blood pressure control, and cardiovascular dysfunction. Exercise interventions improved aerobic fitness, muscular strength, and vascular parameters, although blood pressure reductions varied across studies. Higher physical activity and cardiorespiratory fitness were associated with lower cardiovascular and all-cause mortality. Conclusion: Reduced functional capacity and impaired blood pressure regulation are closely interrelated in T2DM and collectively increase cardiovascular risk. Integrated screening and exercise-based management strategies may improve cardiovascular outcomes; however, larger standardized prospective studies are required to establish causal relationships and optimize clinical interventions.