Pillars of Blood Pressure Management in Patients with Type 2 Diabetes Mellitus: Insights from Recent Trials and Emerging Perspectives

Hypertension (HTN) is prevalent among patients with type 2 diabetes mellitus (T2DM), and both conditions are well-established risk factors for cardiovascular diseases (CVDs) and microvascular complications. To mitigate the risk of CVD, a comprehensive management approach for both blood pressure (BP) and glycaemic control is essential. The current therapeutic strategy should be structured around five pillars aimed at confirming HTN, establishing the 10-year CVD risk and its components and focusing on pharmacological treatment alongside lifestyle interventions to achieve BP targets. In clinical practice, the recommended BP target is 120-129/70-79 mmHg, while an optimal target of ≤120/70 mmHg is being explored under research conditions. Further, BP control should be re-evaluated in cases of resistant or uncontrolled HTN, in conjunction with antidiabetic therapies that have demonstrated cardiovascular and renal protective benefits. This five-pillar approach offers a comprehensive and evolving perspective on BP management in patients with T2DM, although certain aspects continue to be refined as new evidence emerges.