Treatment of hypertension in diabetes: a contemporary approach with a focus on improving cardiovascular outcomes

Diabetes mellitus and hypertension are interrelated conditions that predispose patients to cardiovascular disease. The 2015 American Diabetes Association guidelines recommend a blood pressure goal of <140/90 but indicates that a lower goal can be set for some individuals if this can be achieved without undue burden. Renin angiotensin system blockers remain the main stay of treatment in hypertensive diabetics together with lifestyle interventions. Guidelines indicate that combination therapy may be initiated in patients who have a blood pressure 20/10 over the target BP. As discussed in this review, there are several diabetic medications that have antihypertensive effects. Management of hypertension in diabetes mellitus is an important factor in reducing cardiovascular disease in conjunction with other cardiovascular disease prevention strategies such as use of stains and aspirin. Patients will benefit from multidisciplinary team expertise including a primary care provider, endocrinologist, hypertension specialist, diabetic educator and dietician.