From the Guidelines
The blood pressure threshold for treating hypertension in patients with diabetes should be <130/80 mmHg, as recommended by the most recent guidelines 1. This is based on the latest evidence from the 2025 standards of care in diabetes, which suggests that treating patients with diabetes to a blood pressure goal of <130/80 mmHg can significantly reduce cardiovascular event rates. The ADVANCE trial, which included 11,140 people with type 2 diabetes, found that treatment with perindopril and indapamide to an achieved systolic blood pressure of 135 mmHg significantly decreased cardiovascular event rates compared with a placebo treatment with an achieved blood pressure of 140 mmHg 1. Key points to consider when treating hypertension in patients with diabetes include:
- Initiating antihypertensive therapy when blood pressure exceeds 130/80 mmHg
- Using first-line medications such as ACE inhibitors or angiotensin receptor blockers, which offer additional renal protection beyond blood pressure control
- Titrating medications upward as needed to achieve target blood pressure
- Regularly monitoring blood pressure, kidney function, and electrolytes when initiating and maintaining antihypertensive therapy The 2025 guidelines 1 also note that there is an absence of high-quality data available to guide blood pressure goals in people with type 1 diabetes, but a similar blood pressure goal of <130/80 mmHg is recommended for people with type 1 diabetes. In contrast, older studies such as the 2007 European Society of Hypertension guidelines 1 recommended a target blood pressure of <140/90 mmHg for hypertensive patients, but the more recent evidence 1 supports a lower threshold for patients with diabetes. Overall, the current evidence supports a more aggressive approach to blood pressure management in patients with diabetes, with a goal of reducing cardiovascular risk and preventing diabetes-related complications.
From the Research
Blood Pressure Threshold for Treating Hypertension in Patients with Diabetes
- The optimum target for systolic and diastolic blood pressure in diabetic patients with hypertension is still debated 2.
- Current and emerging evidence supports a blood pressure therapeutic target of < 130/90 mmHg in adults at increased risk for cardiovascular disease, including diabetics 2.
- The 2017 American College of Cardiology/American Heart Association guidelines recommend a threshold blood pressure of ≥130/80 mmHg for diagnosis of hypertension and treating hypertension to a goal BP of <130/80 mmHg 3.
- A study found that evidence from randomized trials does not support blood pressure targets lower than the standard targets in people with elevated blood pressure and diabetes 4.
- However, another study suggests that thresholds and targets for hypertension management in adults with type 2 diabetes should remain at 130/80 mmHg 5.
Key Findings
- A blood pressure target of < 130/80 mmHg is recommended for adults with diabetes 2, 5, 3.
- Lowering blood pressure reduces target organ damage and prevents cardiovascular disease outcomes 5.
- Angiotensin receptor blockers have similar cardiovascular protective effects as angiotensin-converting enzyme inhibitors in patients with diabetes 6.
Clinical Implications
- Healthcare providers should aim to achieve a blood pressure target of < 130/80 mmHg in adults with diabetes 2, 5, 3.
- The choice of antihypertensive medication, such as angiotensin receptor blockers or angiotensin-converting enzyme inhibitors, should be individualized based on patient characteristics and comorbidities 6.