Treatment of Elevated Blood Pressure in Type 2 Diabetes and Hypertension
Adults with type 2 diabetes who also have hypertension represent a high-risk group in which blood pressure control is a primary strategy for reducing cardiovascular morbidity and mortality. This protocol defines when to start treatment, what the targets are, and how comorbid kidney findings shape agent selection.
Clinical Scenario
This protocol applies to adults with concurrent type 2 diabetes and hypertension — a combination that drives elevated cardiovascular risk and requires precise, guideline-based blood pressure management.
Treatment Goals
- SBP goal below 130 mm Hg, with encouragement to reach below 120 mm Hg
- DBP goal below 80 mm Hg
Approach — Partial Overview
Antihypertensive drug therapy is initiated once specific blood pressure thresholds are met. The choice of first-line agent class may be further guided by the presence or absence of kidney-related findings. See the full protocol for the complete selection algorithm and sequencing.
References
DOI: 10.1161/CIR.0000000000001356
- In adults with T2D and hypertension, antihypertensive drug treatment should be initiated at an SBP of ≥130 mm Hg with a treatment goal of <130 mm Hg, with encouragement to achieve an SBP <120 mm Hg to reduce CVD morbidity and mortality.
- In adults with T2D and hypertension, antihypertensive drug treatment should be initiated at a DBP of ≥80 mm Hg with a treatment goal of <80 mm Hg to reduce CVD morbidity and mortality.
- In adults with T2D and hypertension, all first-line classes of antihypertensive agents (ie, thiazide-type diuretics, long-acting CCB, ACEi, and ARB) are useful and effective for BP lowering.
- In adults with diabetes and hypertension, ACEi or ARB are recommended in the presence of CKD as identified by eGFR <60 mL/min/1.73 m² or albuminuria ≥30 mg/g and should be considered when mild albuminuria (<30 mg/g) is present to delay progression of diabetes-related kidney disease.
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