Treating hypertension in type 2 diabetes

INTRODUCTION: The co-existence of hypertension and diabetes mellitus is very common. Hypertension remarkably increases the cardiovascular risk in diabetic patients. Lowering blood pressure (BP) in these patients is particularly beneficial. AREAS COVERED: This paper will discuss what the target BP is for diabetic patients and how that target can be reached. EXPERT OPINION: Previous guidelines recommended lowering BP < 130/80 mmHg in diabetic patients. However, recent studies did not support this target and accordingly most recent guidelines recommend lowering BP to < 140/90 mmHg in diabetic patients. Non-pharmacological approaches are recommended in all patients. If BP levels are above the target despite non-pharmacological treatment, drug therapy should be initiated. Despite the lack of clear evidence, blockers of the renin-angiotensin-aldosterone system (RAAS) represent the cornerstone of the antihypertensive arsenal; however, in most patients combination therapy is required. Combination of RAAS blocker and a calcium antagonist is the preferred one. In many patients three or four drugs are needed. Treatment should be individualized according to concomitant risk factors and diseases and according hemodynamic and laboratory parameters as well as age. In order to maximally reduce cardiorenal risk, lipid and glycemic control should also be achieved.