Navigating arterial hypertension target in diabetic patients

Abstract

Background. Hypertension in diabetic patients needs to be treated while simultaneously preventing hypotensive complications. Since Diabetes Mellitus can affect both small and large vessels, very low blood pressure is an indirect catalyst for the thrombus related complications. Hence, a debate to set SBP target is needed. Objective(s). Analyzing the updates and research, especially in the last decade, to understand the advisory for treating hypertension in patients with diabetes mellitus and propose modifications for the same. Materials and methods. A systematic literature review was conducted using the PubMed and Google Scholar databases. The search targeted publications from January 2020 to May 2025, using the Keywords: "arterial hypertension," "diabetes mellitus," and "treatment." Original articles, systematic reviews, and observational studies were included. Results. Studies show that an intensive SBP target of 120-140mmHg is better. Emdin et al. (2015) found that reducing SBP <140mmHg reduces the risk of coronary heart disease, CVD and mortality, while achieving SBP <130mmHg was insignificant. Brunstrom and Carlberg (2016) reassured that risk of heart failure, myocardial infarction and mortality reduces in patients with baseline SBP ≥140mmHg, but it increases with every 10mmHg decrease below SBP 140mmHg. Thomopoulos et al. (2017) argues that reducing targets below 130 mmHg provides no added protection. Significant reductions in stroke, CHD, and all-cause mortality is achieved by SBP between 130-140mmHg. Conclusion(s). It is recommended to target the SBP between 130-140 mm Hg in patients with diabetes, since it shall help provide a better cardiovascular outcomes, symptomatic control, reduction in mortality while simultaneously avoid potential complications from highly aggressive hypotensive treatment.