Abstract
High blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.
Highlights
Cardiovascular disease (CVD) continues to be the most frequent cause of morbidity and mortality in adults
The purpose of this review is to make a critical literature analysis regarding the optimal blood pressure (BP) thresholds to be targeted for the population with type 2 diabetes mellitus (DM) (T2DM), and the CV outcomes associated with that goal, including a general anti-arterial hypertension (AH) approach in this population
The findings indicated that in patients achieving an systolic blood pressure (SBP) level below 140 mm/Hg, the relative and absolute risk of most CV outcomes was significantly lower in people with DM than in non-DM individuals
Summary
Cardiovascular disease (CVD) continues to be the most frequent cause of morbidity and mortality in adults. The coexistence of both conditions (AH and DM) represents a priori a higher CVR than either of them individually Considering that both pathologies share common metabolic aspects (insulin resistance, dyslipidemia obesity, endothelial dysfunction, atherosclerosis, among other factors), it is believed that the AH population when diagnosed with DM represents a high risk of mortality from all causes, when compared against normotensive non-diabetic individuals. It has been established that the prevalence of AH is 1.5-2.0 times higher in diabetics than in the non-diabetic population, indicating that a significant number of individuals with T2DM have AH at the time of diagnosis and its frequency depends on associated factors, including: level of obesity, severity of atherosclerosis, insulin resistance, advanced age (which probably includes the presence of essential AH) and glomerular filtration rate [16,17]. This frequency may be influenced by the fact that when both conditions have been present for a long time (isolated) in the same individual, increase the probability of co-existence [18,19]
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