Target Blood Pressure in Diabetes Mellitus: A Review

Individuals with diabetes mellitus (DM) are 2–4 times more prone to develop atherosclerotic cardiovascular diseases (ASCVD) than general population and often are affected at younger age. ASCVD is the leading cause of mortality and morbidity in diabetes patients. ASCVD accounts for 25% of all deaths in India, higher than the global average as per Global Burden of Disease study.[1] Several clinical trials have established the relation of high blood pressure (BP) with ASCVD. A BP of ≥140/90 mmHg was strongly associated with stable angina, myocardial infarction, and intracerebral hemorrhage even in non-diabetes subjects. Hypertension is more common in people with type 2 diabetes than in the general population and per se is a major risk factor for ASCVD. The prevalence of hypertension in adult DM patients is estimated to be 73.6% in the US population. Similar hypertension prevalence was found by Gupta et al. among Indian diabetes population with ASCVD risk.[2,3] Patients with DM often have metabolic syndrome comprising hypertension, obesity, and dyslipidemia. The coexistence of DM and hypertension leads to major adverse cardiovascular events such as myocardial infarction, stroke, and microvascular complications such as retinopathy and nephropathy. The United Kingdom Prospective Diabetes Study (UKPDS36) group evaluated the effect of high BP on macrovascular and microvascular complications. A systolic BP (SBP) of ≥160 mmHg had twice as high macrovascular complications as individuals with SBP <120 mmHg. There was an increase in both microvascular and macrovascular complications above SBP of 120 mmHg.[4] This trial highlights the association between hypertension in diabetics and complications of diabetes potentially opening a window for further trials.