Should we change the target blood pressure in diabetic patients? Gadi Shlomai Ehud Grossman* The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel-Aviv University, Israel *Correspondence to: Ehud Grossman, Head of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. E-mail: grosse@post.tau.ac.il Received: 7 November 2011 Accepted: 28 February 2012 Summary Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality in diabetic patients. Guidelines recommend lowering blood pressure (BP) to less than 130 ⁄ 80 mmHg in diabetic patients. These recom- mendations are based on several studies in diabetic patients that showed the benefit of intensive BP control. However in all the studies the achieved BP was higher than 130 ⁄ 80 mmHg. Re-evaluation of earlier studies, as well as more recently accumulated data suggest that intensive BP control is associ- ated with a significant reduction in all-cause mortality and stroke rate, but with no benefit for other microvascular or macrovascular (cardiac, renal and retinal) outcomes. Intensive BP control is associated with an increased risk of serious adverse effects, particularly for systolic BPs levels lower than 130 mmHg. When determining the target BP in diabetic patients one should balance the potential cerebrovascular protection against the increased risk of serious side effects, and the absence of benefit for other circulatory system. It seems therefore, that lowering BP to levels close to 130 ⁄ 80 mmHg should be the main goal of treatment in diabetic patients. Keywords diabetes mellitus; target blood pressure; treatment Introduction Diabetes mellitus (DM) type 2 is associated with a significantly increased risk for macrovascular, as well as microvascular complications [1]. The incidence of hypertension in patients with type 2 diabetes is remarkably high, com- pared to their healthy counterparts [2], thus representing a major modifiable risk factor for cardiovascular morbidity and mortality [3]. While the mecha- nisms underlying the pathologic effects of diabetes and hypertension on the vasculature somewhat differ, their co-existence is profoundly devastating [4]. Coronary heart disease is far more common in patients with both diabetes and hypertension compared to those who have either the former or the lat- ter disease. Concordantly, the simultaneous presence of diabetes and hyper- tension results in a more severe form of cardiomyopathy, as well as a greater incidence of congestive heart failure [5]. Systolic hypertension directly correlates to stroke occurrence rates in all age groups [6]. Similarly, diabetes adversely affects the cerebrovascular arte- rial circulation, increasing the risk for stroke [7], an effect particularly enhanced among hypertensive patients [8]. The extent of these destructive effects is not limited to the macrovasculature. For example, both diabetes and hypertension are leading etiologies for the development of end stage renal disease [9]. As such, the development of hypertension in diabetic REVIEW ARTICLE Copyright Ó 2012 John Wiley & Sons, Ltd. DIABETES/METABOLISM RESEARCH AND REVIEWS Diabetes Metab Res Rev 2012; 28(Suppl 2): 1–7. Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/dmrr.2348