Impact of Blood Pressure Control on Stroke and Myocardial Infarction Risk in Hypertensive Patients With and Without Diabetes: A Narrative Review

Hypertension (HTN) is a well-acknowledged and modifiable risk factor that significantly increases the risk of cardiovascular disease. Left uncontrolled, HTN may result in severe complications, including myocardial infarction and stroke. Also, when HTN coexists with diabetes, the adverse effects on cardiovascular health are amplified as a result of the combined vascular and metabolic effects. This narrative review synthesizes evidence from large observational cohorts, randomized clinical trials (e.g., Systolic Blood Pressure Intervention Trial or SPRINT, Action to Control Cardiovascular Risk in Diabetes or ACCORD), and contemporary guideline recommendations to assess these outcomes. The coexistence of diabetes mellitus with hypertension may further worsen vascular health through combined metabolic and endothelial effects, increasing rates of myocardial infarction and stroke. While pharmacological blood pressure (BP) lowering and lifestyle interventions (e.g., sodium restriction, exercise) generally reduce risk, overly aggressive diastolic BP reduction (< 60 mmHg) can pose hazards in older adults or patients with chronic kidney disease. Current strategies adjust systolic and diastolic targets based on individual factors, age, comorbidity burden, and baseline cardiovascular risk and may include combined drug regimens, dietary counseling, or device‑based therapies. Further studies should prospectively evaluate optimal BP targets in under‑represented populations (e.g., elderly ≥ 75 years, chronic kidney disease stages 3-5, sub‑Saharan cohorts) and compare pharmacologic versus lifestyle‑only strategies, particularly in patients with multiple comorbidities.