Antihypertensive therapy in diabetes mellitus: efficacy, safety, and metabolic impacts in type 1 and type 2 diabetes

Treating hypertension in diabetic patients with antihypertensive medications should be done with careful consideration because these medications may interfere with macro- and microvascular complications of diabetes, such as myocardial infarction, stroke, and diabetic nephropathy. Some medications also come with cardio- and reno-protective effects along with lowering blood pressure. This narrative review focuses on major antihypertensive drug classes and their efficacy, safety, and metabolic impacts in type 1 and type 2 diabetes mellitus. We found that most classes of drugs, such as ACEIs (Angiotensin-Converting Enzyme Inhibitors), ARBs (Angiotensin II-Receptor Blockers), and thiazide diuretics, exert cardio- and renoprotective effects but also come with their own set of side effects, including dry cough, hyperkalemia, and hypokalemia, respectively. Beta blockers are used when patients have underlying conditions such as a previous heart attack or angina, but with caution, as they can cause masking of hypoglycemia. This review also discusses emerging therapies such as SGLT2 (Sodium-Glucose CoTransporter-2) inhibitors. Hence, all these drugs can offer additional benefits in addition to lowering blood pressure if chosen properly and tailored to suit the patient’s overall health needs.