Fast Five Quiz: Type 2 Diabetes and Hypertension

Romesh Khardori, MD, PhD


February 22, 2022

Unequivocal evidence shows that pharmacologic treatment of blood pressure ≥ 140/90 mm Hg reduces cardiovascular events as well as some microvascular complications. Additionally, meta-analyses of clinical trials show that antihypertensive treatment of people with diabetes and baseline blood pressure ≥140/90 mm Hg reduces the risk for atherosclerotic cardiovascular disease, heart failure, retinopathy, and albuminuria. Thus, most patients with type 1 or type 2 diabetes who have hypertension should, at a minimum, be treated to blood pressure targets of < 140/90 mm Hg. However, for select patients with diabetes, intensification of antihypertensive therapy to target blood pressures lower than < 140/90 mm Hg (eg, < 130/80 or < 120/80 mm Hg) may be beneficial if they can be achieved without unnecessary treatment burden.

Certain antidiabetic agents are associated with improvements in blood pressure. Theoretically, hyperinsulinemia and exogenous insulin may lead to hypertension through vasoconstriction and sodium and fluid retention; however, insulin can also promote vasodilation. In the ORIGIN trial from 2012, basal insulin compared with standard care was not associated with a change in blood pressure in people with type 2 diabetes or prediabetes. Sodium-glucose cotransporter 2 inhibitors are associated with a mild diuretic effect and a reduction in blood pressure of 3-6 mm Hg systolic blood pressure and 1-2 mm Hg diastolic blood pressure, and glucagon-like peptide 1 receptor agonists are also associated with a reduction in systolic/diastolic blood pressure of 2-3/0-1 mm Hg.

In randomized studies of people with diabetes, treatment of obstructive sleep apnea has been shown to improve blood pressure.

Learn more about the treatment of hypertension.

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