Blood pressure management in patients with type 2 diabetes mellitus

Hypertension aggravates macrovascular and microvascular diseases and mortality in patients with type 2 diabetes mellitus (T2DM). The current Japanese Society of Hypertension Guidelines of the Management of Hypertension (JSH 2014) recommends that antihypertensive medication should be initiated concomitantly with lifestyle modification when blood pressure (BP) is ⩾130/80 mm Hg and that target levels of office and home BP should be <130/80 mm Hg and <125/75 mm Hg, respectively, in T2DM patients. Considering more favorable metabolic profiles and renoprotective effects than other classes of antihypertensive agents, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are recommended as the first-line therapy for patients with hypertension and T2DM in JSH 2014. However, the target BP and the first-line therapy remain controversial because of the paucity of high-quality evidence with consistency. It is suggested that BP management should be tailored for each patient with T2DM, based on tolerability and considerations of comorbidity.