Advances on Long-Term Antihypertensive Treatment and Diabetes

Diabetes and hypertension commonly occur together, and their coexistence markedly increases the risk of developing both macrovascular and microvascular complications. Blood pressure targets should be established through a shared decision-making process that considers the absolute benefits and harms of treatment, patient comorbidities, and personal preference. A blood pressure target of ≤130/80 mmHg is appropriate for most people with diabetes, and treatment should begin with single-pill combination antihypertensives when available. Management should also focus on glucose control and on controlling other cardiovascular and renal risk factors including elevated cholesterol, lack of physical activity, obesity, and cigarette smoking. There is great potential for the development of a “diabetic polypill” that includes established oral hypoglycemic agents such as metformin and sodium-dependent glucose cotransporter 2 inhibitors, together with antihypertensives and a statin to target multiple risk factors simultaneously, while also optimizing convenience and adherence. This chapter will discuss some of the recent trends in blood pressure management in diabetes and focus on a personalized approach toward blood pressure goals, the importance of sustained blood pressure control, the role of fixed dose combination therapies, and the emergence of a variety of polypills.