From the Guidelines
For patients with diabetes, the ideal blood pressure target is to achieve a systolic blood pressure of less than 130 mmHg and a diastolic blood pressure of less than 80 mmHg, if tolerated, with consideration of individualized goals based on age, comorbidities, and risk of hypotension. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of blood pressure control in reducing the risk of micro- and macrovascular complications in patients with diabetes mellitus (DM) 1. The key points to consider in managing blood pressure in patients with DM include:
- Targeting a systolic blood pressure of less than 130 mmHg, with a range of 130-139 mmHg for older people (aged >65 years) 1
- Targeting a diastolic blood pressure of less than 80 mmHg, but not less than 70 mmHg 1
- Initiating lifestyle modifications, including weight loss, reduced sodium intake, increased physical activity, and limiting alcohol consumption, before starting pharmacological therapy
- Using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as first-line agents, with the addition of calcium channel blockers or diuretics as needed to achieve blood pressure targets 1
- Monitoring blood pressure regularly, with home measurements encouraged to assess control, and adjusting treatment as needed to minimize the risk of adverse effects, such as hypotension, syncope, and falls 1. It is essential to individualize blood pressure targets based on the patient's absolute cardiovascular risk, with more intensive targets (<130/80 mmHg) recommended for those with high risk (10-year ASCVD risk ≥15%) and less stringent targets (<140/90 mmHg) for those with low risk or at high risk of adverse effects 1.
From the Research
Ideal Blood Pressure for Patients with Diabetes Mellitus
The ideal blood pressure (BP) for patients with diabetes mellitus (DM) is a topic of ongoing research and debate. Several studies have investigated the optimal BP targets for patients with DM to reduce the risk of macro and microvascular complications.
Recommended Blood Pressure Targets
- A blood pressure target of less than 130/80 mmHg is commonly recommended for patients with DM, as it offers the most promising degree of protection against cardiovascular and renal events 2, 3, 4, 5.
- However, some studies suggest that a systolic blood pressure goal of "well below" 140 mmHg may be more realistic and effective 6.
- A meta-analysis concluded that a systolic blood pressure target of 130-135 mmHg may be more appropriate for most patients with type 2 diabetes 6.
- For patients with DM and nephropathy, a blood pressure target of around 135/85 mmHg may be recommended, with a goal of closer to 130/80 mmHg for those at highest cardiovascular risk 4.
Individualized Approach to Blood Pressure Control
- An individualized approach to blood pressure control is recommended, taking into account factors such as age, diabetes duration, and presence of vascular or non-vascular co-morbidities 6, 4.
- For younger patients with shorter diabetes duration, a more ambitious strategy may be applied, while a more cautious approach may be necessary for elderly and frail patients 6.
- The risk of stroke and coronary events should also be considered when determining the target blood pressure, with lower blood pressure targets potentially providing greater protection against stroke 6, 4.