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Abstract
The prevalence of diabetes mellitus continues to increase worldwide, and it is a well-established cardiovascular risk factor. Hypertension is also an important cardiovascular risk factor to be controlled and is common among patients with diabetes mellitus. Optimal blood pressure (BP) goals have been the subject of great debate in the management of hypertension among patients with diabetes mellitus. This review provides detailed results from randomized controlled trials and meta-analyses of clinical outcomes according to the target BP in patients with type 2 diabetes mellitus. In addition, the target BP in patients with diabetes mellitus recommended by different guidelines was summarized and presented. A target BP of <140/90 mm Hg is recommended for patients with hypertension and diabetes mellitus, and BP should be controlled to <130/80 mm Hg in patients with diabetes mellitus who have high-risk clinical features. We hope that this review will be helpful to clinicians and patients by promoting the understanding and appropriate application of BP control in the comprehensive management of patients with diabetes mellitus.
Introduction
The prevalence of type 2 diabetes mellitus continues to increase worldwide, with 537 million adults aged 20 to 79 years suffering from diabetes mellitus in 2021. It is estimated that this number will increase to 783 million by 2045 according to the International Diabetes Federation Diabetes Atlas [1]. The prevalence of diabetes mellitus has also consistently increased in the last 7 years in Korea, with an estimated prevalence of 16.7% in 2020 [2]. Diabetes mellitus is a well-established modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) [3–6] and ranks among the top 10 leading causes of disability-adjusted life-years [7]. High blood pressure (BP) is also the most important risk factor for ASCVD which can be controlled, and hypertension is common among patients with diabetes mellitus [3,8]. According to the Korean hypertension fact sheet 2020, 26% of all hypertensive patients >20 years of age received diabetes mellitus treatment together [9]. In addition, 58.6% of patients with adult diabetes mellitus have hypertension, and only 55.5% of them have hypertension controlled with a BP of 140/85 mm Hg according to the Diabetes Fact Sheet in Korea 2021 [2]. Since uncontrolled high BP is an important risk factor for heart failure (HF), atrial fibrillation, chronic kidney disease, valvular heart disease, dementia, coronary heart disease (CHD), and stroke, it is necessary to properly control BP [3,10]. However, the optimal BP target has been a subject of great debate among patients with diabetes mellitus, and there are differences in the target BP of active control in previous studies and recommendations by each guideline. Considering these differences and the divergence of opinions, clinicians may be confused about BP management in patients with diabetes mellitus.
In this article, we have detailed reviews on how to set the optimal BP target in patients with diabetes mellitus and diabetes mellitus with various comorbidities, based on recent evidence and guidelines.